Abstract：
OBJECTIVE: People with psychotic disorders have a higher risk of mortality following cancer diagnosis, compared to people without psychosis. The extent to which this disparity is influenced by differences in cancer-related treatment is currently unknown. We hypothesized that, following a cancer diagnosis, people with psychotic disorders were less likely to receive treatment and were at higher risk of death than those without psychosis.
METHODS: We constructed a retrospective cohort of cases of non-affective psychotic disorder (NAPD) and a general population comparison group, using Ontario Health (OH) administrative data. We identified cases of all cancers diagnosed between 1995 and 2019 and obtained information on cancer-related treatment and mortality. Cox proportional hazards models were used to compare the probability of having a consultation with an oncologist and receiving cancer-related treatment, adjusting for tumor site and stage. We also compared the rate of all-cause and cancer-related mortality between the two groups, adjusting for tumor site.
RESULTS: Our analytic sample included 24 944 people diagnosed with any cancer. People with NAPD were less likely to receive treatment than people without psychosis (HR = 0.87, 95% CI = 0.82, 0.91). In addition, people with NAPD had a greater risk of death from any cause (HR = 1.68, 95% CI = 1.60, 1.76), compared to people without NAPD.
CONCLUSIONS: The lower likelihood of receiving cancer treatment reflects disparities in accessing cancer care for people with psychotic disorders, which may partially explain the higher mortality risk following cancer diagnosis. Future research should explore mediating factors in this relationship to identify targets for reducing health disparities.
METHODS: We constructed a retrospective cohort of cases of non-affective psychotic disorder (NAPD) and a general population comparison group, using Ontario Health (OH) administrative data. We identified cases of all cancers diagnosed between 1995 and 2019 and obtained information on cancer-related treatment and mortality. Cox proportional hazards models were used to compare the probability of having a consultation with an oncologist and receiving cancer-related treatment, adjusting for tumor site and stage. We also compared the rate of all-cause and cancer-related mortality between the two groups, adjusting for tumor site.
RESULTS: Our analytic sample included 24 944 people diagnosed with any cancer. People with NAPD were less likely to receive treatment than people without psychosis (HR = 0.87, 95% CI = 0.82, 0.91). In addition, people with NAPD had a greater risk of death from any cause (HR = 1.68, 95% CI = 1.60, 1.76), compared to people without NAPD.
CONCLUSIONS: The lower likelihood of receiving cancer treatment reflects disparities in accessing cancer care for people with psychotic disorders, which may partially explain the higher mortality risk following cancer diagnosis. Future research should explore mediating factors in this relationship to identify targets for reducing health disparities.
摘要：
目的：患有精神病的人在癌症诊断后死亡的风险更高，与没有精神病的人相比。目前尚不清楚这种差异受癌症相关治疗差异影响的程度。我们假设，癌症诊断后，与没有精神病的人相比，患有精神病的人接受治疗的可能性较小，死亡风险更高。
方法：我们建立了一个非情感性精神障碍（NAPD）病例的回顾性队列和一个普通人群对照组，使用安大略省卫生(OH)行政数据。我们确定了1995年至2019年期间诊断的所有癌症病例，并获得了癌症相关治疗和死亡率的信息。Cox比例风险模型用于比较与肿瘤科医生会诊和接受癌症相关治疗的概率。调整肿瘤部位和分期。我们还比较了两组的全因死亡率和癌症相关死亡率，调整肿瘤部位。
结果：我们的分析样本包括24.944名被诊断患有任何癌症的人。NAPD患者接受治疗的可能性低于无精神病患者(HR=0.87,95%CI=0.82,0.91)。此外,NAPD患者因任何原因死亡的风险更大(HR=1.68,95%CI=1.60,1.76),与没有NAPD的人相比。
结论：接受癌症治疗的可能性较低反映了精神病患者在获得癌症治疗方面的差异，这可能部分解释了癌症诊断后较高的死亡风险。未来的研究应该探索这种关系中的中介因素，以确定减少健康差异的目标。
方法：我们建立了一个非情感性精神障碍（NAPD）病例的回顾性队列和一个普通人群对照组，使用安大略省卫生(OH)行政数据。我们确定了1995年至2019年期间诊断的所有癌症病例，并获得了癌症相关治疗和死亡率的信息。Cox比例风险模型用于比较与肿瘤科医生会诊和接受癌症相关治疗的概率。调整肿瘤部位和分期。我们还比较了两组的全因死亡率和癌症相关死亡率，调整肿瘤部位。
结果：我们的分析样本包括24.944名被诊断患有任何癌症的人。NAPD患者接受治疗的可能性低于无精神病患者(HR=0.87,95%CI=0.82,0.91)。此外,NAPD患者因任何原因死亡的风险更大(HR=1.68,95%CI=1.60,1.76),与没有NAPD的人相比。
结论：接受癌症治疗的可能性较低反映了精神病患者在获得癌症治疗方面的差异，这可能部分解释了癌症诊断后较高的死亡风险。未来的研究应该探索这种关系中的中介因素，以确定减少健康差异的目标。
