Breaking News
September 26, 2018 - New insights into what drives organ transplant rejection
September 26, 2018 - Tiny Device Is a ‘Huge Advance’ for Treatment of Severe Heart Failure
September 26, 2018 - Research shows possibility to postpone cumbersome treatment for low-risk MDS patients
September 26, 2018 - CSU chemists may help in making extracorporeal life support devices more effective
September 26, 2018 - Blood-brain barrier can be important biomarker for early diagnosis of Alzheimer’s disease
September 26, 2018 - PCORI, AHRQ announce awards to support patient-centered outcomes research in learning health systems
September 26, 2018 - Scientists discover and characterize human skeletal stem cells
September 26, 2018 - Repeat CT Common in Peds Traumatic Epidural Hematoma
September 26, 2018 - Genetics Home Reference: bunion
September 26, 2018 - Increase observed in hearts from drug-intoxicated donors
September 26, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 26, 2018 - TINY cancer detection device shows promise as point-of-care detector of KSHV
September 26, 2018 - Women with non-small cell lung cancers live longer than their male counterparts
September 26, 2018 - KTU researchers engineer experimental bone to help treat osteoarthritis patients
September 26, 2018 - Foundation for a Smoke-Free World calls for proposals to implement Smoke-Free Index
September 26, 2018 - Functional Imagery Training helps lose five times more weight than talking therapy
September 26, 2018 - Fewer American Teens Having Sex, Most Using Birth Control
September 26, 2018 - We are predisposed to forgive, new research suggests
September 26, 2018 - Insomnia Exacts Heavy Toll on Quality of Life
September 26, 2018 - Clinical study shows efficacy, safety of novel drug-eluting stent with improved radiographic visibility
September 26, 2018 - Cytox, AIBL announce expanded agreement to assess genetic risk for Alzheimer’s
September 26, 2018 - Study finds persistent rate of lawnmower injury-related emergency department visits
September 26, 2018 - Researchers find molecule that halts, reverts neurodegeneration caused by Parkinson’s disease
September 26, 2018 - Novartis announces winners of 2018 eXcellence in Ophthalmology Vision Award
September 26, 2018 - New spinout company to tackle drug-resistant infections with novel antibiotics
September 26, 2018 - In depression the brain region for stress control is larger
September 26, 2018 - Smuggling RNA into cells can activate the immune system to fight cancer
September 26, 2018 - Special Focus Issue takes wide view of complementary and integrative medicine in cancer
September 26, 2018 - Researchers now confirm that genome duplication drives evolution of species
September 25, 2018 - Study provides evidence of beta lactamase producing, antimicrobial resistant E. coli in U.S. retail meat
September 25, 2018 - UCI study finds new cause of cerebral microbleeds
September 25, 2018 - Researchers propose mechanism by which ASTN2 protein defects lead to brain disorders
September 25, 2018 - Chinese and German researchers to cooperate more closely in future for better food
September 25, 2018 - Recent study helps predict probability of pregnant mothers to have child with autism
September 25, 2018 - New online, sound matching tool offers tinnitus sufferers potential treatment options
September 25, 2018 - UC Davis researchers take critical step in developing more effective Salmonella vaccine
September 25, 2018 - Antibiotics best paediatric treatment for children’s chronic wet cough
September 25, 2018 - Looking beyond opioids: Stanford pain psychologist briefs Congress
September 25, 2018 - Organs actively fighting back against autoimmune diseases, finds study
September 25, 2018 - Lancaster professor aims to understand how genes affect smoking cessation
September 25, 2018 - Human-oriented perspective needed to better understand Parkinson’s disease
September 25, 2018 - Physical activity may have beneficial effects for people with rare Alzheimer’s disease
September 25, 2018 - FDA Updates on Valsartan Recalls
September 25, 2018 - 3-D-printed tracheal splints used in groundbreaking pediatric surgery
September 25, 2018 - Who is the designated driver, or proxy, for your health decisions?
September 25, 2018 - New chemo-optogenetic method enables multi-directional activity control of cellular processes
September 25, 2018 - Study explores link between genetic predisposition to Alzheimer’s and cardiometabolic risk factors
September 25, 2018 - NeoTract presents new clinical data from studies of UroLift System for patients with BPH
September 25, 2018 - Patients with paralysis manage to walk thanks to new technology
September 25, 2018 - Statins Improve Long-Term Survival After AAA Repair
September 25, 2018 - Novel brain network linked to chronic pain in Parkinson’s disease
September 25, 2018 - Researchers reassess negative pressure wound therapy as its benefit and harm remain unclear
September 25, 2018 - Older adults with ‘fall plan of care’ less likely to suffer fall-related hospitalizations
September 25, 2018 - FDA lifts partial clinical hold that paused enrollment of new patients in tazemetosta clinical trials
September 25, 2018 - IME Medical Electrospinning establishes state-of-the-art manufacturing lab facilities
September 25, 2018 - Phase 1 and 2 clinical trials of entrectinib drug in ROS1-positive NSCLC show promising results
September 25, 2018 - How to Protect Your Eyesight
September 25, 2018 - Novel approach allows researchers to define how cells in the retina respond to diabetes
September 25, 2018 - Columbia University announces winners of 2018 Louisa Gross Horwitz Prize
September 25, 2018 - New model enables anyone to run powerful simulations, complex calculations easily
September 25, 2018 - Clinical trial investigators found non-compliant with requirement to report results on EU register
September 25, 2018 - Study analyzes quality of protein supplements in function of source, treatment and storage
September 25, 2018 - FDA grants Orphan Drug Designation to Myelo001 for treatment of Acute Radiation Syndrome
September 25, 2018 - U.S. Alzheimer’s Cases to Nearly Triple by 2060
September 25, 2018 - Improving cell replacement therapy for Parkinson’s disease
September 25, 2018 - Genervon reports new findings that drug candidate GM6 attenuates Alzheimer’s disease in mice model
September 25, 2018 - FDA approves new 5 mm diameter drug-eluting stent from Cook Medical
September 25, 2018 - New $17.8 million grant ensures USC at forefront of research on tobacco-related health risks
September 25, 2018 - Researchers analyze response to combination immunotherapy for patients with rare skin cancer
September 25, 2018 - Study sheds light on how brain protein may be involved neurodevelopmental disorders
September 25, 2018 - Where to draw the line on incentives
September 25, 2018 - Solid fuel use linked with increased risk of hospitalization or death from respiratory diseases
September 25, 2018 - ‘Trouble Brewing’ report highlights steps that governments can take to reduce alcohol-related harms
September 25, 2018 - Recurrence risk of VTE appears similar for patients with cancer and those with unprovoked VTE
September 25, 2018 - Global leaders must make bold commitments at first-ever UN tuberculosis summit
September 25, 2018 - Brief sleep intervention works long-term to prevent child obesity
September 25, 2018 - Vaping among kids and teens a growing concern
September 25, 2018 - Public launch of products and application solutions from Porvair Laboratory Division
September 25, 2018 - Harmful H. pylori may play a role in Parkinson’s disease
September 25, 2018 - Researchers develop way to measure different types of fear of falling in patients with Parkinson’s
Mortality Risk Doubles When Breast Ca Patient Has Mental Illness

Mortality Risk Doubles When Breast Ca Patient Has Mental Illness

image_pdfDownload PDFimage_print

Action Points

  • Note that this analysis of a Medicare dataset found that a history of mental illness was associated with a significant increase in all-cause mortality among women with breast cancer.
  • This may largely be driven by later stage at diagnosis, implying that increased efforts to ensure proper screening may partially address the disparity in outcomes.

Elderly women with breast cancer who have severe mental illness have twice the risk of all-cause mortality as their peers without mental illness, and need more screening, surveillance, and coordinated care from primary care providers and specialists, researchers said.

Results from a large retrospective cohort study revealed an adjusted hazard ratio (HR) of 2.19 in breast cancer patients with severe mental illness compared with those without, according to Melissa L. Santorelli, PhD, of Rutgers School of Public Health in Piscataway, New Jersey, and colleagues.

The 5-year cumulative incidence for all-cause mortality in women with severe mental illness was 38.0%, compared with 19.4% in breast cancer patients without mental illness after adjusting for age, income, race, ethnicity, geographic location, and marital status (P<0.001), the study authors reported online in the Journal of Clinical Oncology.

There was also a statistically significant higher rate of all-cause mortality for women with depression (HR 1.39 after adjusting for age, income, race/ethnicity, SEER location, and marital status) and anxiety and depression (adjusted HR 1.26) than for women with no history of mental illness — likely because of late presentation and delayed diagnosis, the researchers said.

“Our descriptive analysis shows that patients with severe mental illness were diagnosed with later-stage breast cancer more frequently compared with patients without mental illness, which suggests that delayed diagnosis might play a role in survival disparities.”

Breast cancer patients with pre-existing severe mental illness may also be at increased risk of an aggressive form of advanced breast cancer, the researchers cautioned. Although a 20% increased hazard for breast cancer-specific death was observed in these patients, the adjusted HR (1.20) was not significant.

The study was conducted using SEER (Surveillance, Epidemiology, and End Results) and Medicare data on 19,028 women diagnosed with stages I to IIIa breast cancer from 2005 to 2007. Although 80% of patients did not have mental illness, 2.6% had a diagnosis of pre-existing bipolar disorder, schizophrenia, or some other psychotic disorder in the 3 years prior to breast cancer diagnosis. In addition, 7.7% of the study population had a diagnosis of depression, 6.0% had been diagnosed with anxiety, and 3.6% had both anxiety and depression.

When compared with women without mental illness, a larger proportion of patients with severe mental illness had:

  • Diagnosis beyond stage I (46.4% versus 40.2%)
  • Tumor larger than 20 mm (37.6% versus 30.3%)
  • Poorly differentiated tumors (28.0% versus 24.0%)
  • One or more positive lymph nodes at the time of initial diagnosis (40.7% versus 33.2%)

Clinicians need to be aware of these increased risks, step up screening efforts, and work collaboratively with other specialists to improve patient care, the researchers emphasized. Breast cancer patients with pre-existing severe mental illness were also more likely to have a lower median income, and were less likely to be married, the study showed.

“Primary care physicians must place an emphasis on early detection among women with severe mental illness to improve the likelihood that guideline-recommended screening mammograms occur,” Santorelli and colleagues wrote. “They also should work closely with psychiatrists and oncologists on the coordination of care for these patients.”

Similarly, oncologists need to make sure that surveillance mammograms are part of follow-up care for women with severe mental illness who are diagnosed with breast cancer, and more research is needed to better understand how mental illness reduces survival and to identify the best coordination of care models to improve patient outcomes.

Although breast cancer mortality has been declining over the past 30 years, it is estimated that in 2017, approximately 40,000 women in the United States will die from the disease. Elderly women have the highest incidence of breast cancer by age, the researchers pointed out.

The negative impact of mental health on mortality is not confined to patients with breast cancer, the team added. For example, an earlier meta-review of the literature showed that patients with severe mental disorders had an up to 150% increased risk of all-cause mortality.

In an accompanying editorial, Alison R. Hwong, MD, PhD, and Christina Mangurian, MD, of the University of California San Francisco, agreed that many questions remain — for example, the role of psychotropic medications in breast cancer morbidity and mortality needs to be better understood as well as how treatment decisions may differ for patients with severe mental illness.

“Future mixed-methods studies should examine patient understanding of and preference for treatment along with quality and outcomes data that compare women with and without severe mental illness.”

Noting that barriers to diagnosis and treatment currently exist for women with mental illness, Hwong and Mangurian warned that preventive care and treatment needs to be integrated into community mental health clinics “or these women will be overlooked.”

“We believe that preventive healthcare services should be delivered where women are already receiving care, especially for patients with severe mental illness who may have cognitive difficulties in accessing care, are marginally housed, and have low income,” the editorial continued. “Mobile mammography administrators could partner with community mental health clinics to deliver care where the patient already is being seen.”

Screening mammograms for this patient population wouldn’t be technically difficult to implement, but time and money will be needed as well as “an institutional commitment to improving overall medical care for people with severe mental illness.”

Limitations of the study, Santorelli et al noted, include the lack of assessment for psychiatric medications as well as the fact that behavioral factors such as alcohol and substance abuse were not evaluated. In addition, the results may not be generalizable to patients other than elderly women with Medicare coverage.

Santorelli reported having no conflicts of interest; several of the study coauthors reported financial relationships with industry.

Hwang and Mangurian reported having no conflicts of interest.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2017-12-26T12:00:00-0500

Tagged with:

About author

Related Articles