Oncological Care Needs of People With Mental Illness: A Single Institution Experience in Australia

This retrospective cohort study evaluated the oncological care of people with psychiatric conditions at an outer metropolitan center to audit for clinical disparities in comparison to people without psychiatric conditions.

A retrospective review of multidisciplinary team meetings was conducted, and those with comorbid psychiatric disorders (cases) were identified. Demographic, psychiatric, and oncological data were collected. Psychiatric conditions were stratified into three categories: Cat1: mild affective disorders; Cat2: complicated affective disorders, substance use disorder, and post-traumatic stress disorder; and Cat3: severe mental illness (SMI) (e.g., bipolar affective disorder and schizophrenia). A control group of people without psychiatric conditions (Cat0) was selected at random from matched MDMs. A comparison between cases and controls for differences in cancer outcomes was performed.

Between 2021 and 2022, 853 people were discussed at MDMs. Of these, 170 (20%) cases were identified, and 57%, 29%, and 14% were in Cat1, Cat2, and Cat3, respectively. A further 170 people without mental illness were included for comparison (Cat0), and the total cohort examined was 340. People in Cat1 (p < 0.001) and Cat3 (p < 0.001) were more likely to present with metastatic or unresectable disease compared to those in Cat0. The treatment offered to Cat3 was more likely to deviate from treatment guidelines (p = 0.001). Cat3 was also found to have significantly reduced recurrence-free survival (hazard ratio 4.27, 95% CI 1.46-12.48, p = 0.008) compared to Cat0.

Psychiatric disorders were associated with worse cancer outcomes compared to those without. This is potentially due to higher rates of treatment non-adherence. This institutional study suggests that people with SMI have increased needs in navigating cancer care and highlights a need to examine this on a larger scale.