Martti Arffman1, Kristiina Manderbacka2, Jaana Suvisaari3, Jussi Koivunen4, Sonja Lumme2, Ilmo Keskimäki5, Aulikki Ahlgren-Rimpiläinen3, Eero Pukkala6. 1. National Institute for Health and Welfare, Health and Social Systems Research, P.O.Box 30, 00271 Helsinki, Finland. Electronic address: martti.arffman@thl.fi. 2. National Institute for Health and Welfare, Health and Social Systems Research, P.O.Box 30, 00271 Helsinki, Finland. 3. National Institute for Health and Welfare, Mental Health Unit, P.O.Box 30, 00271 Helsinki, Finland. 4. Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland; University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland. 5. National Institute for Health and Welfare, Health and Social Systems Research, P.O.Box 30, 00271 Helsinki, Finland; Faculty of Social Sciences, University of Tampere, P.O.Box 100, 33014, Finland. 6. Faculty of Social Sciences, University of Tampere, P.O.Box 100, 33014, Finland; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Unioninkatu 22, 00130, Helsinki, Finland.
Abstract
BACKGROUND: Although the link between severe mental illness (SMI) and elevated cancer mortality is well established, few studies have examined lung cancer survival and SMI in detail. Our study compared cancer-specific mortality in patients with lung cancer with and without a history of SMI and analysed whether mortality differences could be explained by cancer stage at presentation, comorbidity or differences in cancer treatment. METHODS: We identified patients with their first lung cancer diagnosis in 1990-2013 from the Finnish Cancer Registry, their preceding hospital admissions due to SMI from the Hospital Discharge Register and deaths from the Causes of Death statistics. Competing risk analyses were used to estimate hazard ratios (HRs) for the impact of SMI on mortality. RESULTS: Of the 37,852 lung cancer cases, 12% had a history of SMI. Cancer-specific mortality differences were found between patient groups in some cancer types after controlling for stage at representation and treatment. Men with a history of psychosis had excess mortality risk (HR = 1.24, 1.06-1.45) in squamous cell carcinoma. Similar excess risk was found among women with psychosis in small-cell carcinoma (HR = 1.76, 1.41-2.19) and in squamous cell carcinoma (HR = 1.67, 1.26-2.20) and among women with mood disorders in adenocarcinoma (HR = 1.37, 1.08-1.74). Patient group differences in HRs in five-year mortality did not markedly change from the 1990s. CONCLUSIONS: We found elevated cancer-specific mortality among persons with a history of SMI. Collaboration between patients, mental healthcare professionals and oncological teams is needed to reduce the mortality gap between patients with cancer with and without SMI.
BACKGROUND: Although the link between severe mental illness (SMI) and elevated cancer mortality is well established, few studies have examined lung cancer survival and SMI in detail. Our study compared cancer-specific mortality in patients with lung cancer with and without a history of SMI and analysed whether mortality differences could be explained by cancer stage at presentation, comorbidity or differences in cancer treatment. METHODS: We identified patients with their first lung cancer diagnosis in 1990-2013 from the Finnish Cancer Registry, their preceding hospital admissions due to SMI from the Hospital Discharge Register and deaths from the Causes of Death statistics. Competing risk analyses were used to estimate hazard ratios (HRs) for the impact of SMI on mortality. RESULTS: Of the 37,852 lung cancer cases, 12% had a history of SMI. Cancer-specific mortality differences were found between patient groups in some cancer types after controlling for stage at representation and treatment. Men with a history of psychosis had excess mortality risk (HR = 1.24, 1.06-1.45) in squamous cell carcinoma. Similar excess risk was found among women with psychosis in small-cell carcinoma (HR = 1.76, 1.41-2.19) and in squamous cell carcinoma (HR = 1.67, 1.26-2.20) and among women with mood disorders in adenocarcinoma (HR = 1.37, 1.08-1.74). Patient group differences in HRs in five-year mortality did not markedly change from the 1990s. CONCLUSIONS: We found elevated cancer-specific mortality among persons with a history of SMI. Collaboration between patients, mental healthcare professionals and oncological teams is needed to reduce the mortality gap between patients with cancer with and without SMI.
Authors: Marko Elovainio; Sonja Lumme; Martti Arffman; Kristiina Manderbacka; Eero Pukkala; Christian Hakulinen Journal: SSM Popul Health Date: 2021-06-11