Mortality in Elderly, Mentally Ill Breast Cancer Patients
Elderly (68 years of age or older) U.S. women with breast cancer who had severe preexisting mental illness had twice the all-cause mortality hazard as women who were not mentally ill, according to a study by Kristy Iglay, MPH, of the Rutgers School of Public Health and colleagues, published in the Journal of Clinical Oncology. In this retrospective cohort study, there was a 20% increase in the breast cancer–specific mortality hazard as well, but it was not considered significant.
Patients who were severely mentally ill (based on at least one inpatient or two outpatient claims for bipolar disorder, schizophrenia, or other psychotic disorder during the 3 years before breast cancer diagnosis) were more often diagnosed with later-stage breast cancer, suggesting “delayed diagnosis might play a role in survival disparities.”
Patients who have mental illness sometimes must deal with “diagnostic overshadowing,” in which their physical symptoms are seen as caused by their mental illness, the writers noted. Such patients may not be able to understand how important it is to have mammograms or why it is important to start or continue their treatment. Primary care physicians, psychiatrists, and oncologists need to work together to improve early detection and treatment in this population, according to Dr. Iglay and colleagues.