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Cited by 32Global Cancer Incidence and ScreeningCancer survivorship and careWomen's cancer prevention and management

Breast cancer treatment disparities in patients with severe mental illness: A systematic review and meta‐analysis

Open access
Kisely, Steve, Alotiby, Meshary Khaled N., Protani, Melinda M., Soole, Rebecca, Arnautovska, Urska, Siskind, Dan·2023·Psycho-Oncology
DOI 10.1002/pon.6120
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Abstract

Objective: The incidence and mortality rates of breast cancer in individuals with pre‐existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following diagnosis. Methods: We undertook a systematic review and meta‐analysis on access to guideline‐appropriate care following a diagnosis of breast cancer in people with SMI including the receipt of surgery, endocrine, chemo‐ or radiotherapy. We searched for full‐text articles indexed by PubMed, EMBASE, PsycInfo and CINAHL that compared breast cancer treatment in those with and without pre‐existing SMI. Study designs included population‐based cohort or case‐control studies. Results: There were 13 studies included in the review, of which 4 contributed adjusted outcomes to the meta‐analyses. People with SMI had a reduced likelihood of guideline‐appropriate care (RR = 0.83, 95% CI = 0.77–0.90). Meta‐analyses were not possible for the other outcomes but in adjusted results from a single study, people with SMI had longer wait‐times to receiving guideline‐appropriate care. The results for specific outcomes such as surgery, hormone, radio‐ or chemotherapy were mixed, possibly because results were largely unadjusted for age, comorbidities, or cancer stage. Conclusions: People with SMI receive less and/or delayed guideline‐appropriate care for breast cancer than the general population. The reasons for this disparity warrant further investigation, as does the extent to which differences in treatment access or quality contribute to excess breast cancer mortality in people with SMI.

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  • Patients with severe mental illness such as bipolar or schizophrenia are at risk for delayed or below standard treatment resulting in differential outcomes.

    “Of concern, recent studies suggest patients with severe mental illness such as bipolar or schizophrenia are at risk for delayed or below standard treatment resulting in differential outcomes [3].”

    From Psychological Intervention and Breast Cancer (2024) · cites this paper as [3]

    The Discussion reports that patients with bipolar disorders or schizophrenia face greater delays in starting breast cancer treatment, and that people with severe mental illness are less likely to receive guideline-recommended care. The Abstract also reports excess breast cancer mortality, but says further investigation is needed to determine whether differences in treatment access or quality contribute to it; the claimed link to differential outcomes is therefore not established. (LLM, conf=0.88)

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Authors
Kisely, S., Alotiby, M. K. N., Protani, M. M., Soole, R., Arnautovska, U., & Siskind, D.
Affiliations
  • Dalhousie University (CA)
  • The University of Queensland (AU)
  • University of Queensland School of Clinical Medicine Brisbane Queensland Australia
Corresponding author
Kisely, Steve
ORCID
Venue
Psycho-Oncology
Publisher
Wiley
Published
2023-03-14
Volume
32
Issue
5
Pages
651-662
ISSN
  • 1057-9249 (ISSN-L)
  • 1099-1611
DOI
10.1002/pon.6120
OpenAlex
W4323652548
Cited by
31
References
76
Citations by year
2026: 8 · 2025: 11 · 2024: 11 · 2023: 1
FWCI
1.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Psycho-Oncology (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
University of Queensland
Topics
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
breast cancer, severe mental illness, treatment disparities, access to cancer care, treatment delay, breast cancer surgery, hormone therapy, chemotherapy, radiotherapy, schizophrenia, bipolar disorder, major depressive disorder, breast cancer mortality
MeSH terms
Mental Disorders, Breast Neoplasms, Female, Humans, Comorbidity, Case-Control Studies

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