The study, published in the journal BMJ Open, suggests that the problems occur during care (rather than because of a late diagnosis or screening), and it reveals the health inequalities faced by people with mental illness.
In general, people with serious mental illness (SMI), including bipolar disorder, schizophrenia, and schizoaffective disorder, have a life expectancy 15-20 years lower than those without mental illness.
Premature death among people with mental health problems is often due to poor physical health. Conditions such as cancer or heart disease are significantly more common than suicide or violence.
The findings showed that people with SMI had a 74 percent higher risk of death over the four to five year follow-up period compared to cancer patients with no history of mental illness. People with depression (30 percent higher), dementia (66 percent higher), and substance use disorders (42 percent higher) also had worse cancer survival rates.
“We found that people with mental health disorders had worse survival rates than people with no history of mental illness, even though they were not presenting with symptoms of cancer any later than other people. This suggests there is something happening during their care, rather than the problem being late diagnosis or screening,” said lead author Dr. Chin-Kuo Chang.
For the study, anonymous electronic medical records were linked to the Thames Cancer Registry. A total of 28,477 cancer cases (including lung, breast, prostate, and bowel cancer) of people age 15 or over were identified. Of these, 2,206 individuals had been previously assessed or treated in secondary mental health care, with 125 being treated for severe mental illness.
There was no significant difference in how advanced the cancer was at diagnosis for people with and without a history of mental illness. However, the researchers did find that people with mental health disorders had worse survival after a cancer diagnosis, suggesting that the problems occur during their care, rather than being due to late screening or diagnosis.
“Our next step is to understand the barriers to care for people with mental health problems. There are many factors to consider, including how the symptoms of mental illness and medication may affect cancer treatment, as well as the considerable social disadvantage and stigma faced by people with severe mental illness,” said senior author and professor Robert Stewart.
“It is unacceptable that there is such a difference between cancer survival rates for people with mental illness and people without. We need to make sure that people with mental health problems have access to the same standard, quality, and range of healthcare services as everyone else.”
Source: King’s College London