Tuesday, March 21, 2023

Breast Cancer in Women With Severe Mental Illness Often Undertreated, Review Suggests

Women with severe mental illness (SMI)—such as schizophrenia, bipolar disorder, or major depression—are less likely to receive recommended treatment for breast cancer than those without SMI, according to a report in Psycho-Oncology.

Prior studies suggest that death from breast cancer is higher among patients with preexisting SMI compared with those without mental illness. Such higher death rates may be the result of reduced access to early cancer screening; delays in seeking cancer care; and/or a lack of collaboration between psychiatrists, primary care physicians, and oncologists, wrote Steve Kisely, M.D., Ph.D., of the University of Queensland in Australia and colleagues.

Curious about the barriers that patients with SMI experience following a breast cancer diagnosis, the authors compiled and reviewed articles that reported data on whether an SMI diagnosis impacted the receipt of guideline-appropriate cancer treatment (for example, surgery, chemotherapy, radiotherapy, and/or adjuvant endocrine therapy) for adult female breast cancer patients.

Kisely and colleagues included 13 studies in the review, which included a total of 299,193 participants. Of these, four studies estimated the odds of receiving guideline-appropriate breast cancer treatment in people with schizophrenia and related psychotic disorders and/or mood disorders; these were included in a meta-analysis.

The pooled data from the four studies showed that patients with SMI were about 17% less likely to receive guideline-recommended cancer treatment than those without SMI. Kisely and colleagues also found “that patients with bipolar disorders, schizophrenia, and other psychotic disorders had a significantly higher risk of delays to starting cancer treatment of 2 months or more after breast cancer diagnosis, and they were less likely to initiate their adjuvant hormonal therapy within 1 year of their diagnosis.”

The authors concluded, “Our results suggest that greater action is needed to improve access to guideline-appropriate care for breast cancer outcomes of psychiatric patients. In the area of colorectal cancer, people with schizophrenia who received case management including education on screening and patient navigation had higher participation rates compared [with] controls who had treatment a usual. This approach might also be applied to breast cancer treatment including the use of navigators, in combination with collaborative care between general practitioners, oncology, and mental health services.”

For related information, see the Psychiatric Services article “Association Between the Maryland Medicaid Behavioral Health Home Program and Cancer Screening in People With Serious Mental Illness.” 

(Image: iStock/Ridofranz)

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