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Patients With Schizophrenia, Cancer Less Likely to Get End-of-Life Care

Key clinical point: Disparities in end-of-life care exist between cancer patients with schizophrenia and cancer patients without diagnosed mental illness.

Major finding: Schizophrenia patients with cancer are significantly more likely to receive palliative end-of-life care (adjusted odds ratio, 1.61) in the last 31 days of their lives, but less likely to receive chemotherapy or surgery, compared with matched controls without mental illness.

Study details: The results are based on a population-based cohort study of 2,481 adults with schizophrenia and 222,477 controls.

Disclosures: The researchers had no financial conflicts to disclose. The study was supported by the Assistance Publique des Hôpitaux de Marseille and Aix-Marseille University, both in France.

Citation:

Fond G et al. Lancet Public Health. 2019. doi: 10.1016/S2468-2667(19)30187-2.

Commentary:

Cancer survival and quality of life have improved in the general population as a result of earlier detection and substantial advances in treatments and supportive care. However, these advances have not extended to individuals with schizophrenia who develop cancer. In this longitudinal epidemiological analysis, patients with schizophrenia were more likely to receive palliative care but less likely to receive high intensity, end-of-life care, when compared with matched controls. Caring for a person who has both schizophrenia and cancer is challenging, requiring expertise in both oncology and psychiatry. Interventional approaches to reduce cancer-related disparities in mental illness will likely require additional clinician training and multidisciplinary care integration.—Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.