Effect of Mental Disorders on Diagnosis, Treatment, and Survival of Older Adults with Colon Cancer

作者：Baillargeon Jacques^*; Kuo Yong Fang; Lin Yu Li; Raji Mukaila A; Singh Amanpal; Goodwin James S

来源：Journal of the American Geriatrics Society, 2011, 59(7): 1268-1273.

DOI：10.1111/j.1532-5415.2011.03481.x

• colon cancer
• mental health
• access to care

OBJECTIVES: To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer.
DESIGN: Retrospective cohort study.
SETTING: The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database.
PARTICIPANTS: Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer.
MEASUREMENTS: The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer-specific mortality were assessed using Cox proportional hazards regression and logistic regression.
RESULTS: Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR) = 2.09, 95% confidence interval (CI) = 1.86-2.35); and to have received no chemotherapy for Stage 3 cancer (ARR = 1.63, 95% CI = 1.49-1.79). The rate of overall mortality (hazard ratio (HR) = 1.33, 95% CI = 1.31-1.36) and colon cancer-specific mortality (HR = 1.23, 95% CI = 1.19-1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia.
CONCLUSION: Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders. J AmGeriatr Soc 59:1268-1273, 2011.

• 出版日期2011-7