Severe mental illness associated with breast cancer treatment disparities

Key takeaways:

• People with severe mental illness were less likely to receive appropriate care for breast cancer, meta-analyses showed.
• Severe mental illness was associated with longer time to treatment in one study.

Compared with other people with breast cancer, those with a preexisting severe mental illness were less likely to receive appropriate treatment and more likely to experience delays in receiving treatment, findings in Psycho-Oncology showed.

Steve Kisely, PhD, MD, a professor of psychiatry at the University of Queensland School of Clinical Medicine in Australia, and colleagues identified 13 studies that evaluated access to guideline-appropriate treatment after breast cancer diagnosis. All studies were either population-based or case-control by design, with a group of participants having a preexisting diagnosis of severe mental illness, which was defined as having bipolar disorder, major depressive disorder or a major psychotic disorder such as schizophrenia.

Overall, 299,193 participants were included in the meta-analyses, with study cohort sizes ranging from 201 to 80,671. There were six studies including all stages of breast cancer, four that included stages 0 through IIIa, two that included stages I and II and one that included terminal stage cancer.

In four studies that reported the odds of receiving guideline-appropriate care, people with severe mental illness were less likely to receive appropriate care compared with people who did not have a severe mental illness (OR = 0.83; 95% CI, 0.77-0.9).

Similarly, participants with mood disorders were less likely to receive appropriate treatment compared with controls in three studies (OR = 0.85; 95% CI, 0.79-0.92). This tended to be the case in participants with a major psychotic disorder, but the disparity in treatment rates was not significant, the researchers wrote.

There was only one study with data on time to receipt of guideline-appropriate care, which demonstrated longer wait times for participants with severe mental illness compared with controls.

“The results may indicate action required to decrease inequity, and thus improve health outcomes in this group of psychiatric patients,” Kisely and colleagues wrote. “This would include a greater emphasis on earlier diagnosis, and better access to cancer treatment.”