Cancer care for individuals with schizophrenia

Abstract

Individuals with schizophrenia are a vulnerable population that has been relatively neglected in health disparities research. Despite having an equivalent risk of developing most cancers, patients with schizophrenia are more likely to die of cancer than the general population. Cancer care disparities are likely the result of patient-, provider-, and systems-level factors and influenced by the pervasive stigma of mental illness. Individuals with schizophrenia have higher rates of health behaviors linked with cancer mortality including cigarette smoking. They also have significant medical comorbidity, are less likely to have up-to-date cancer screening, and may present at more advanced stages of illness. Patients with schizophrenia may be less likely to receive chemotherapy or radiotherapy, have more postoperative complications, and have less access to palliative care. However, opportunities exist for the interdisciplinary team, including medical, surgical, and radiation oncologists; psychiatrists; and primary care physicians, to intervene throughout the continuum of cancer care to promote survival and quality of life. This review summarizes data on overall and cancer-specific mortality for individuals with schizophrenia and reviews specific disparities across the cancer care continuum of screening, diagnosis, treatment, and end-of-life care. Using a case, the authors illustrate clinical challenges for this population including communication, informed consent, and risk of suicide, and provide suggestions for care. Finally, recommendations for research to address the disparities in cancer care for individuals with schizophrenia are discussed. Despite significant challenges, with collaboration between oncology and mental health teams, individuals with schizophrenia can receive high-quality cancer care. Cancer 2014;120:323-34.

Smoking in male patients with schizophrenia in China: A meta-analysis

“…Schizophrenia patients have an approximately 20% reduced life expectancy compared to the general population (Hennekens et al, 2005) with smoking-related diseases being major contributors to premature death (Irwin et al, 2014;McClave et al, 2010;Ruther et al, 2014). Identifying the patterns of smoking and its correlates in schizophrenia and implementing effective control strategies to reduce its prevalence and harmful consequences is important for policymakers and health professionals.…”

Differences in cancer stage, treatment and in-hospital mortality between patients with and without schizophrenia: retrospective matched-pair cohort study

“…10,[18][19][20][21] The reason for the discrepancy between cancer incidence and mortality in patients with schizophrenia remains unclear; 20 however, potential related factors may include delayed diagnosis and lower likelihood of receiving cancer care. Several studies have found a difference in access to cancer care between patients with schizophrenia and the general population, 22 with those with schizophrenia being less likely to receive screening for cancer. [23][24][25][26] A few studies suggested that people with schizophrenia may have undergone delays in the diagnosis of cancer and initiation of treatment.…”

A staggered edge: End-of-life care in patients with severe mental illness

“…SPMI is associated with premature mortality across all age groups [1,2]. Despite common misassumptions that most individuals with SPMI die prematurely from violence and suicide, the majority of excess mortality is due to chronic diseases such as cancer, heart disease, chronic obstructive pulmonary disease, and dementia [3,4]. Excess mortality from chronic disease is multifactorial; increased substance use and its medical sequelae, decreased engagement with preventive health care, and poor access to medical care all contribute [4].…”

“…Despite common misassumptions that most individuals with SPMI die prematurely from violence and suicide, the majority of excess mortality is due to chronic diseases such as cancer, heart disease, chronic obstructive pulmonary disease, and dementia [3,4]. Excess mortality from chronic disease is multifactorial; increased substance use and its medical sequelae, decreased engagement with preventive health care, and poor access to medical care all contribute [4]. Patients with schizophrenia, for example, have a similar incidence of most cancers to the general population, but these patients have up to a two-fold risk of dying of their disease due to under-detection and under-treatment [4].…”

“…Excess mortality from chronic disease is multifactorial; increased substance use and its medical sequelae, decreased engagement with preventive health care, and poor access to medical care all contribute [4]. Patients with schizophrenia, for example, have a similar incidence of most cancers to the general population, but these patients have up to a two-fold risk of dying of their disease due to under-detection and under-treatment [4]. …”