Pop Paula R, Larsen Gitte S, Thomsen Mette K, Johansen Christoffer, Zachariae Robert, Rafn Bolette Skjødt
Danish Cancer Society National Research Center for Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Danish Cancer Society National Research Center for Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Acta Oncol. 2025 Mar 5;64:358-373. doi: 10.2340/1651-226X.2025.42260.
Persons with severe mental illnesses (SMIs) have reduced participation in colorectal cancer (CRC) screening programs, higher odds of advanced stage at diagnosis, and are less likely to receive adequate treatment than the general population. It remains unclear to what extent these factors impact CRC outcomes for persons with SMI. The aim of this scoping review was to describe and quantify CRC mortality for persons with SMI compared with the general population.
PATIENTS/MATERIALS AND METHODS: We followed the JBI Manual for Evidence Synthesis and PRISMA guidelines in a systematic search of four databases from inception until April 29th, 2024. We included studies that provided CRC mortality estimates for adults with preexisting clinical diagnosis of SMI. We synthesized the results descriptively and pooled the data to estimate the magnitude of the associations.
Twenty-four original studies were identified with a total of 16.4 million persons. Most studies reported increased CRC mortality for persons with SMI compared with persons without SMI. The meta-analysis demonstrated a 25% increased CRC mortality for persons with SMI (e.g. pooled hazard ratio 1.25; 95% confidence interval 1.13 to 1.39; n = 13,178,161).
The evidence points consistently to an increased CRC mortality for persons with SMI compared with persons without SMI. Furthermore, this evidence supports the idea that persons with SMI are a heterogenous population, and as such, any future initiatives to improve CRC outcomes for persons with SMI would warrant a tailored approach to potentiate individual resources, to mitigate stigma and structural discrimination.
患有严重精神疾病（SMI）的人群参与结直肠癌（CRC）筛查项目的比例较低，诊断时处于晚期的几率较高，且与普通人群相比，接受充分治疗的可能性较小。目前尚不清楚这些因素在多大程度上影响患有SMI的人群的结直肠癌预后。本范围综述的目的是描述和量化患有SMI的人群与普通人群相比的结直肠癌死亡率。
患者/材料与方法：我们遵循JBI循证综合手册和PRISMA指南，对四个数据库进行了系统检索，检索时间从数据库创建至2024年4月29日。我们纳入了为已存在SMI临床诊断的成年人提供结直肠癌死亡率估计的研究。我们对结果进行了描述性综合，并汇总数据以估计关联程度。
共识别出24项原始研究，涉及总计1640万人。大多数研究报告称，与没有SMI的人相比，患有SMI的人结直肠癌死亡率更高。荟萃分析表明，患有SMI的人结直肠癌死亡率增加了25%（例如，合并风险比1.25；95%置信区间1.13至1.39；n = 13178161）。
证据一致表明，与没有SMI的人相比，患有SMI的人结直肠癌死亡率更高。此外，这一证据支持了这样一种观点，即患有SMI的人群是一个异质性群体，因此，未来任何改善患有SMI的人群结直肠癌预后的举措都需要采取一种量身定制的方法，以增强个人资源，减少耻辱感和结构性歧视。
