RESEARCH WEEKLY: Schizophrenia linked to Higher Mortality from Cancer
By Nina Robertson
Individuals with schizophrenia are at a 50% increased risk of dying from cancer, according to a recent review published in the Current Opinion in Psychiatry. Findings indicate that a substantial proportion of patients with schizophrenia who die from cancer are less likely to receive effective treatment, are not diagnosed until after death, or are diagnosed with cancer in more advanced stages.
Study details and results
The review, performed by researchers from the Copenhagen Research Centre for Mental Health, examined articles published in 2018, 2019, 2020 to present estimates of incidence rates and excess mortality of cancer for patients with schizophrenia compared to the general population. They also explored rates of undiagnosed and undertreatment to analyze a possible direct correlation in increased mortality.
Individuals who have schizophrenia are less likely to have been diagnosed more than thirty days prior to death by cancer, according to the results. A majority of the patients with schizophrenia have not been diagnosed or received any hospital-based treatment before death. Additionally, the incidence rate of cancer based on hospital diagnosis for individuals with schizophrenia most likely underestimates the true incidence of cancer, according to the results. This indicates that more people with schizophrenia are living with cancer than are officially diagnosed or aware. It is necessary to consider why cancer is not diagnosed before death of those with schizophrenia.
The review authors also examined previously published research that confirmed an increased mortality from breast, lung and colon cancer in patients with schizophrenia. For example, in a recent Danish population study, which included 7.4 million people, an increased mortality risk for patients with schizophrenia was identified with a mortality rate ratio of 1.41 for men and 1.36 for women. In a meta-analysis based on seven studies, the pooled results indicated increases in mortality of cancer dependent on diagnosis.
The discrepancy between incidence of cancer and mortality of cancer highlights a barrier to treatment and suggests that patients with schizophrenia are diagnosed with cancer in more advanced stages. Other research included in the review found that the probability of having been diagnosed prior to dying from cancer was reduced for patients with schizophrenia, resulting in a decrease in hospital-based treatment.
Individuals with schizophrenia who are diagnosed with cancer are also less likely to receive guideline treatment for their symptoms, according to the study authors. Stigma and perception that patients are not likely to comply with complicated diagnostic procedures exhibits how society and clinicians are failing a vulnerable portion of the population. More findings cited in the review show that patients with schizophrenia receive less optimal treatment and screening than patients without schizophrenia that are diagnosed with the same type of cancer. Together, these results indicate that patients with schizophrenia are not diagnosed with cancer due to difficulties in identifying signs of illness and ensuring proper assessment, a lack of access to healthcare and treatment, misinterpretation of discrete symptoms, or lack of guideline treatment once diagnosed.
Implications
This review further supports the findings that schizophrenia is associated with an increased risk of dying from cancer, including having a higher incidence of the disease and higher mortality rates. Patients with schizophrenia are diagnosed with cancer in more advanced stages, less likely to receive effective treatment, or often not diagnosed until after death. These trends amplify the need for solutions to highlight the voices and health of those with schizophrenia.
The authors suggest it is essential to conduct more studies of organ-specific cancer and how to address incidence and mortality for people with schizophrenia. For example, to combat lung cancer mortality in individuals with schizophrenia, smoking cessation programs should be offered alongside screening programs to better evaluate life-style factors contributing to mortality of this vulnerable group. Implementing procedures to facilitate access to early diagnosis and effective treatment of cancer can save the lives of thousands.
“A potential explanation for the lack of research regarding links of cancer and schizophrenia is that patients with schizophrenia might have reduced recognition of physical warning signs, lower level of help seeking behavior, difficulties in breaking through barriers in healthcare services and reduced access to healthcare due to insufficient or absent insurance,” the authors write. More preventable measures are needed along with substantially higher rates of screening for cancers in persons with schizophrenia.
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