Cara Bergamo1, Keith Sigel, Grace Mhango, Minal Kale, Juan P Wisnivesky. 1. From the Doris Duke Clinical Research Fellowship (C.B.), UMDNJ-Robert Wood Johnson Medical School, Camden, New Jersey; and Divisions of General Internal Medicine (K.S, G.M., M.K, J.W.) Pulmonary and Critical Care (J.W.), Mount Sinai School of Medicine, New York, New York.
Abstract
OBJECTIVE: Cancer mortality is higher in individuals with schizophrenia, a finding that may be due, in part, to inequalities in care. We evaluated gaps in lung cancer diagnosis, treatment, and survival among elderly individuals with schizophrenia. METHODS: The Surveillance, Epidemiology, and End Results database linked to Medicare records was used to identify patients 66 years or older with primary non-small cell lung cancer. Lung cancer stage, diagnostic evaluation, and rates of stage-appropriate treatment were compared among patients with and without schizophrenia using unadjusted and multiple regression analyses. Survival was compared among groups using Kaplan-Meier methods. RESULTS: Of the 96,702 patients with non-small cell lung cancer in the Surveillance, Epidemiology, and End Results database, 1303 (1.3%) had schizophrenia. In comparison with the general population, patients with schizophrenia were less likely to present with late-stage disease after controlling for age, sex, marital status, race/ethnicity, income, histology, and comorbidities (odds ratio = 0.82, 95% confidence interval = 0.73-0.93) and were less likely to undergo appropriate evaluation (p < .050 for all comparisons). Adjusting for similar factors, patients with schizophrenia were also less likely to receive stage-appropriate treatment (odds ratio = 0.50, 95% confidence interval = 0.43-0.58). Survival was decreased among patients with schizophrenia (mean survival = 22.3 versus 26.3 months, p = .002); however, no differences were observed after controlling for treatment received (p = .40). CONCLUSIONS: Elderly patients with schizophrenia present with earlier stages of lung cancer but are less likely to undergo diagnostic evaluation or to receive stage-appropriate treatment, resulting in poorer outcomes. Efforts to increase treatment rates for elderly patients with schizophrenia may lead to improved survival in this group.
OBJECTIVE:Cancer mortality is higher in individuals with schizophrenia, a finding that may be due, in part, to inequalities in care. We evaluated gaps in lung cancer diagnosis, treatment, and survival among elderly individuals with schizophrenia. METHODS: The Surveillance, Epidemiology, and End Results database linked to Medicare records was used to identify patients 66 years or older with primary non-small cell lung cancer. Lung cancer stage, diagnostic evaluation, and rates of stage-appropriate treatment were compared among patients with and without schizophrenia using unadjusted and multiple regression analyses. Survival was compared among groups using Kaplan-Meier methods. RESULTS: Of the 96,702 patients with non-small cell lung cancer in the Surveillance, Epidemiology, and End Results database, 1303 (1.3%) had schizophrenia. In comparison with the general population, patients with schizophrenia were less likely to present with late-stage disease after controlling for age, sex, marital status, race/ethnicity, income, histology, and comorbidities (odds ratio = 0.82, 95% confidence interval = 0.73-0.93) and were less likely to undergo appropriate evaluation (p < .050 for all comparisons). Adjusting for similar factors, patients with schizophrenia were also less likely to receive stage-appropriate treatment (odds ratio = 0.50, 95% confidence interval = 0.43-0.58). Survival was decreased among patients with schizophrenia (mean survival = 22.3 versus 26.3 months, p = .002); however, no differences were observed after controlling for treatment received (p = .40). CONCLUSIONS: Elderly patients with schizophrenia present with earlier stages of lung cancer but are less likely to undergo diagnostic evaluation or to receive stage-appropriate treatment, resulting in poorer outcomes. Efforts to increase treatment rates for elderly patients with schizophrenia may lead to improved survival in this group.
Authors: Susan M Frayne; Donald R Miller; Erica J Sharkansky; Valerie W Jackson; Fei Wang; Jewell H Halanych; Dan R Berlowitz; Boris Kader; Craig S Rosen; Terence M Keane Journal: Am J Med Qual Date: 2009-10-23 Impact factor: 1.852
Authors: Hoa L Nguyen; Robert J Goldberg; Joel M Gore; Keith A A Fox; Kim A Eagle; Enrique P Gurfinkel; Frederick A Spencer; George Reed; Ann Quill; Frederick A Anderson Journal: Coron Artery Dis Date: 2010-09 Impact factor: 1.439
Authors: Kelly E Irwin; Beverly Moy; Lauren E Fields; Catherine A Callaway; Elyse R Park; Lori Wirth Journal: J Clin Oncol Date: 2019-04-15 Impact factor: 44.544
Authors: Jacob E Berchuck; Craig S Meyer; Ning Zhang; Caroline M Berchuck; Neil N Trivedi; Beth Cohen; Sunny Wang Journal: JAMA Oncol Date: 2020-07-01 Impact factor: 31.777
Authors: Kelly E Irwin; Elyse R Park; Lauren E Fields; Amy E Corveleyn; Joseph A Greer; Giselle K Perez; Catherine A Callaway; Jamie M Jacobs; Andrew A Nierenberg; Jennifer S Temel; David P Ryan; William F Pirl Journal: Oncologist Date: 2019-01-29
Authors: Kelly E Irwin; Elyse R Park; Jennifer A Shin; Lauren E Fields; Jamie M Jacobs; Joseph A Greer; John B Taylor; Alphonse G Taghian; Oliver Freudenreich; David P Ryan; William F Pirl Journal: Oncologist Date: 2017-05-30
Authors: Lara C Weinstein; Ana Stefancic; Amy T Cunningham; Katelyn E Hurley; Leopodo J Cabassa; Richard C Wender Journal: CA Cancer J Clin Date: 2015-12-10 Impact factor: 508.702
Authors: Kelly E Irwin; Naomi Ko; Elizabeth P Walsh; Veronica Decker; Isabel Arrillaga-Romany; Scott R Plotkin; Jeffrey Franas; Emily Gorton; Beverly Moy Journal: Oncologist Date: 2022-07-05 Impact factor: 5.837