Effect of Mental Disorders on Diagnosis, Treatment, and Survival of Older Adults with Colon Cancer

Abstract

OBJECTIVES To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer. DESIGN Retrospective cohort study. SETTING The Surveillance, Epidemiology and End Results (SEER)–Medicare linked database. PARTICIPANTS Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer. MEASUREMENTS The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer-specific mortality were assessed using Cox proportional hazards regression and logistic regression. RESULTS Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR) =2.09, 95% confidence interval (CI) =1.86–2.35); and to have received no chemotherapy for Stage 3 cancer (ARR =1.63, 95% CI =1.49–1.79). The rate of overall mortality (hazard ratio (HR) =1.33, 95% CI =1.31–1.36) and colon cancer-specific mortality (HR =1.23, 95% CI =1.19–1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia. CONCLUSION Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders.

Prognostic Significance of Dementia in Older Adults with Solid Tumors

“…This hypothesis was supported by Hamaker et al's [13 ]study in 2012, which found that >33% of nursing home patients who were suspected of having breast cancer had not been referred for further investigations, especially when the patients also had advanced dementia. Furthermore, mental disorder patients were found to be 4 times more likely to be diagnosed with colon cancer at autopsy as were elderly patients without mental disorders [14]. …”

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

“…Several previous studies with small sample sizes have reported delayed cancer diagnosis among patients with psychiatric disorders: there was an increased proportion of diagnosis at autopsy 35 and having metastasis on presentation, 18,28 as well as suggested delays in initiating treatment after diagnosis. 18 Other limited studies have reported a reduced likelihood of patients with psychiatric illness undergoing cancer treatment.…”

“…18 Other limited studies have reported a reduced likelihood of patients with psychiatric illness undergoing cancer treatment. 18,28,35 Those studies lacked detailed clinical data, including cancer stage and comorbidities. The present study involved a national large-scale database, which included detailed patient characteristics.…”

Increased cancer-specific mortality in individuals developing mental disorders after cancer diagnosis: biomedical factors versus psychosocial support

“…The role of mental health is gaining greater prominence in outcomes research; and increasingly, recent studies are investigating cancer-related outcomes (1,2), including cancer screening, stage at diagnosis, receipt of treatment, and survival, in the presence of comorbid mental conditions. Prior studies have documented excess cancer mortality in people with mental illness (3,4).…”