JAMA Psychiatry：精神病患者发生转移癌风险高
2013-03-08 李妍 编译 中国医学论坛报
澳大利亚一项研究显示，在获得癌症诊断时，精神病患者出现转移癌风险更高，且更少接受专业干预。论文发表于《美国医学会杂志·精神病学》[JAMA Psychiatry 2013，70（2）：209]。 通过收集精神健康记录、癌症登记及死亡记录等，研究者发现，与普通人群相比，精神病患者癌症发病率较低（男性和女性的率比分别为0.86和0.92），但死亡率较高（男女的率比分别为1
澳大利亚一项研究显示，在获得癌症诊断时，精神病患者出现转移癌风险更高，且更少接受专业干预。论文发表于《美国医学会杂志·精神病学》[JAMA Psychiatry 2013，70（2）：209]。
通过收集精神健康记录、癌症登记及死亡记录等，研究者发现，与普通人群相比，精神病患者癌症发病率较低（男性和女性的率比分别为0.86和0.92），但死亡率较高（男女的率比分别为1.52和1.29），且就诊时发生转移癌的比例更高（7.1%对6.1%）；精神病患者更少接受手术治疗，尤其是结肠癌、乳腺癌和宫颈癌患者。此外，罹患乳腺癌、结肠癌和子宫癌的患者更少接受放疗，且接受的化疗疗程更少。
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Context
There is a 30% higher case fatality rate from cancer in psychiatric patients even though their incidence of cancer is no greater than in the general population. The reasons are unclear, but if increased cancer mortality were due to lifestyle only, cancer incidence should be similarly increased. Other hypotheses include delays in presentation, leading to more advanced staging at diagnosis, and difficulties in treatment access following diagnosis.
Objective
To assess why psychiatric patients are no more likely than the general population to develop cancer but are more likely to die of it.
Design, Setting, and Patients
A population-based record-linkage analysis compared psychiatric patients with the Western Australian population, using an inception cohort to calculate rates and hazard ratios. Mental health records were linked with cancer registrations and death records from January 1, 1988, to December 31, 2007, in Western Australia.
Main Outcome Measures
Metastases, incidence, mortality, and access to cancer interventions.
Results
There were 6586 new cancers in psychiatric patients. Cancer incidence was lower in psychiatric patients than in the general population in both males (rate ratio = 0.86; 95% CI, 0.82-0.90) and females (rate ratio = 0.92; 95% CI, 0.88-0.96), although mortality was higher (males: rate ratio = 1.52; 95% CI, 1.45-1.60; females: rate ratio = 1.29; 95% CI, 1.22-1.36). The proportion of cancer with metastases at presentation was significantly higher in psychiatric patients (7.1%; 95% CI, 6.5%-7.8%) than in the general population (6.1%; 95% CI, 6.0%-6.2%). Psychiatric patients had a reduced likelihood of surgery (hazard ratio = 0.81; 95% CI, 0.76-0.86), especially resection of colorectal, breast, and cervical cancers. They also received significantly less radiotherapy for breast, colorectal, and uterine cancers and fewer chemotherapy sessions.
Conclusions
Although incidence is no higher than in the general population, psychiatric patients are more likely to have metastases at diagnosis and less likely to receive specialized interventions. This may explain their greater case fatality and highlights the need for improved cancer screening and detection.
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#Psychiatry#
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#转移癌#
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#精神病患者#
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#癌风险#
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