Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates
Abstract
Objective: To investigate the association between mental illness and cancer incidence, mortality and case fatality. Method: A population‐based record linkage study was undertaken based on 172 932 patients of mental health services in Western Australia. Records of mental health service contacts were linked with cancer registrations and death records. Results: While there was little difference in overall cancer incidence rates between psychiatric patients and the general community (RR in males 1.05, 95% CI 1.02–1.09, RR in females 1.02, 0.98–1.05), cancer mortality was 39% higher in males (95% CI: 32–46%) and 24% higher in females (17–32%). Conclusion: People with mental illness in Western Australia do not show an increased incidence rate of cancer, but do have higher cancer mortality. This was attributed to a higher cancer case fatality rate among people with mental illness.
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Patients with psychiatric disorders receive less treatment for physical conditions than do people without psychiatric disorders.
“This interpretation is supported by studies documenting that patients with psychiatric disorders receive less treatment for physical conditions than do people without psychiatric disorders (Kisely et al. 2009, Laursen et al. 2009, Lawrence et al. 2000).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Lawrence et al. 2000
Some studies have demonstrated a decreased cancer risk in schizophrenia.
“Some studies have demonstrated a decreased cancer risk in schizophrenia (440-448).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [444]
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“decreased cancer risk in schizophrenia (440-448).”
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Cancer-Related Mortality in People With Mental Illness
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The epidemiology of excess mortality in people with mental illness
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Catts, V. S., Catts, S. V., O’Toole, B. I., & Frost, A. D. J. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01163.x · Cited by 209 · see citing works
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Catalá-López, F., Suárez‐Pinilla, M., Suárez‐Pinilla, P., Valderas, J. M., Gómez-Beneyto, M., Martı́nez, S., Balanzá‐Martínez, V., Climent, J., Valencia, A., McGrath, J. J., et al. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000356498 · Cited by 201 · see citing works
“…(1.24, 2.01) 1.95 Gulbinat et al., 1992 (Hawaii Caucasian) [46] 0.78 (0.46, 1.31) 0.91 Gulbinat et al., 1992 (Denmark) [46] 0.80 (0.75, 0.86) 2.72 Lawrence et al., 2000 [47] 1.01 (0.91, 1.12) 2.60 Lichtermann et al., 2001 [48] 1.17 (1.09, 1.25) 2.72 Grinshpoon et al., 2005 [50] 0.89 (0.84, 0.93)…”
InfluentialCancer care for individuals with schizophrenia
Irwin, K. E., Henderson, D. C., Knight, H. P., & Pirl, W. F. (2013) · Cancer · doi:10.1002/cncr.28431 · Cited by 191 · see citing works
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“Numerous studies have found that persons diagnosed with schizophrenia have a reduced risk to develop cancer (Gulbinat et al., 1992; Mortensen, 1994; Lawrence et al., 2000; Cohen et al., 2002; Oksbjerg Dalton et al., 2003).”
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BackgroundExcess Cancer Mortality in Psychiatric Patients
Kisely, S., Sadek, J., MacKenzie, A., Lawrence, D., & Campbell, L. A. (2008) · The Canadian Journal of Psychiatry · doi:10.1177/070674370805301107 · Cited by 128 · see citing works
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InfluentialSelf-citationDisability Status, Mortality, and Leading Causes of Death in the United States Community Population
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“Prior studies have shown significant associations between mental/substance use impairment and mortality from heart diseases,(30) and malignant neoplasms.(31) Overall, this study’s results are generalizable to community-dwelling adults in the United States.”
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“Although the evidence is not unequivocal, findings more consistently point to a higher standardized mortality ratio within SMI populations.(8,35,36) Various factors may contribute to higher mortality, including more advanced stage at presentation because of delayed diagnosis, comorbidities that complicate treatment (i…”
ResultMai, Q., Holman, C. D. J., Sanfilippo, F. M., Emery, J. D., & Preen, D. B. (2011) · BMC Medicine · doi:10.1186/1741-7015-9-118 · Cited by 104 · see citing works
“Variables and measurements Exposure variables We ascertained the principal mental health diagnosis for each MHC using a previously published method [3], which assigned patients to their most significant mental health diagnosis on an hierarchy of severity (Table 1).”
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“Within Australia, two population-based studies of overall mortality in psychiatric patients also found conflicting results (Drew, 2005; Lawrence et al., 2000b).”
BackgroundMethodResultInfluentialSelf-citationReview: Are there modifiable risk factors which will reduce the excess mortality in schizophrenia?
Wildgust, H. J., & Beary, M. (2010) · Journal of Psychopharmacology · doi:10.1177/1359786810384639 · Cited by 93 · see citing works
“However, a number of studies have found that the increased cancer or heart disease mortality cannot always be explained by increased incidence, which suggests that the excess deaths are at least partially associated with poorer patient access to, and poorer quality of, health care (Kisely et al., 2007, 2008; Laursen e…”
BackgroundCancer mortality in patients with schizophrenia: systematic review and meta-analysis
Zhuo, C., Tao, R., Jiang, R., Lin, X., & Shao, M. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.116.195776 · Cited by 93 · see citing works
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“, 2005) equivalent (Goldacre et al., 2005; Oksbjerg et al., 2003; Lawrence et al., 2000), and lower (Barak et al.”
Iglay, K., Santorelli, M. L., Hirshfield, K. M., Williams, J. M., Rhoads, G. G., Lin, Y., & Demissie, K. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2017.73.4947 · Cited by 89 · see citing works
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The paradox of premature mortality in schizophrenia: new research questions
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“There is evidence that people with schizophrenia are less likely to receive cancer screening and secondary care interventions even if identified with a disorder (Lawrence et al., 2000; Kisely et al., 2007, 2008).”
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Cardiovascular diseases among patients with schizophrenia
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Archer, J. A., Hutchison, I. L., & Korszun, A. (2008) · Journal of Oral Pathology and Medicine · doi:10.1111/j.1600-0714.2008.00635.x · Cited by 72 · see citing works
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Self-citationUnmet needs in the management of schizophrenia
Torres‐González, F., Ibáñez-Casas, I., Saldivia, S., Ballester, D., Pamela Grandón, F., Moreno‐Küstner, B., Xavier, M., & Gómez-Beneyto, M. (2014) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s41063 · Cited by 60 · see citing works
“More important from an organizational perspective, a large-scale study conducted in Australia showed that despite the lower incidence of neoplasm in schizophrenia patients, mortality resulting from cancer was increased (39% higher in men and 24% higher in women; range, 17%–32%) when compared with the general populatio…”
Lithium treatment and cancer incidence in bipolar disorder
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“(iii) Confounding factors influencing cancer incidence such as alcohol intake, food behavior patterns, obesity, somatic disorders, socio-economic group, smoking habits, and physical activity may influence the results when comparing the GP to patients with BD, and also when comparing lithium-treated patients to other p…”
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Schizophrenia and Cancer: In 2010 Do We Understand the Connection?
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“Recent data from Nova Scotia, where there is a universal health care system (hence private insurance does not play a role), found significant elevation of cancer mortality by 72% in males and 59% in females that could not be explained by cancer incidence rates.21 The total cancer IRR of 1.21 was significantly less tha…”
MethodInfluentialMai, Q., Holman, C. D. J., Sanfilippo, F. M., & Emery, J. D. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-163 · Cited by 52 · see citing works
“Exposure variables We ascertained the principal mental health diagnosis for each MHC using a previously published method [11,22], which assigned patients to their most significant mental health diagnosis on an hierarchy of severity (see Additional File 1, Table S1).”
MethodClinical Experience With the Management of Schizophrenia in the General Hospital
Freudenreich, O., & Stern, T. A. (2003) · Psychosomatics · doi:10.1176/appi.psy.44.1.12 · Cited by 54 · see citing works
Osborn, D., Limburg, H., Walters, K. R., Petersen, I., King, M., Green, J., Watson, J. R., & Nazareth, I. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.11.009 · Cited by 54 · see citing works
“An Australian study found that although cancer incidence is similar in people with SMI, there may be a higher case fatality rate, perhaps due to later presentation or not receiving similar cancer interventions (Lawrence et al., 2000).”
Ishikawa, H., Yasunaga, H., Matsui, H., Fushimi, K., & Kawakami, N. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.114.156265 · Cited by 53 · see citing works
Cancer in patients with schizophrenia: W hat is the next step?
Chou, F. H., Tsai, K., Wu, H., & Shen, S. (2016) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12420 · Cited by 53 · see citing works
“Several population-based incidence studies have found a decreased cancer risk in people with schizophrenia.(9,10,12,14,15,17,18,23,30,31,34) This finding has led to theories that people with schizophrenia may have a tumor suppressor gene or enhanced internal natural killer cell activities.”
BackgroundInfluentialBerchuck, J. E., Meyer, C. S., Zhang, N., Berchuck, C. M., Trivedi, N. N., Cohen, B. E., & Wang, S. (2020) · JAMA Oncology · doi:10.1001/jamaoncol.2020.1466 · Cited by 53 · see citing works
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Kisely, S. R., Preston, N. J., Xiao, J., Lawrence, D. M., Louise, S., Crowe, E., & Segal, S. P. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.01.010 · Cited by 47 · see citing works
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Self-citationHealth inequalities and the health needs of people with mental illness
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“Also, cancer incidence was almost identical in people with mental illness as the general population, but cancer mortality was 40 per cent higher in people with mental illness.(6)”
BackgroundSelf-citationUse of Administrative Data for the Surveillance of Mood and Anxiety Disorders
Kisely, S., Lin, E., Gilbert, C., Smith, M., Campbell, L., & Vasiliadis, H. (2009) · Australian and New Zealand journal of psychiatry (Print) · doi:10.3109/00048670903279838 · Cited by 48 · see citing works
Physical Illness and Schizophrenia
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Risk of cancer among patients with depressive disorder: a meta‐analysis and implications
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“44, and three studies [14,23,25] were deemed high quality.”
BackgroundMcCarter, K. L., Baker, A., Britton, B., Wolfenden, L., WRATTEN, C. R., Bauer, J. D., Halpin, S. A., Carter, G. L., Beck, A. K., Leigh, L., et al. (2018) · Cancer Medicine · doi:10.1002/cam4.1497 · Cited by 41 · see citing works
“Depression in cancer patients is associated with increased morbidity and possibly increased mortality [6, 7].”
BackgroundPsychiatric disorder as a first manifestation of cancer: A 10‐year population‐based study
Benros, M. E., Laursen, T. M., Dalton, S. O., & Mortensen, P. B. (2009) · International Journal of Cancer · doi:10.1002/ijc.24274 · Cited by 42 · see citing works
“It has been proposed that patients with psychiatric disorders may be at greater risk for delay in diagnosis or treatment of malignancy.(25) Although our findings certainly seem to confirm this in the sense that patients are referred to a psychiatric hospital setting with symptoms that are likely to be caused by an und…”
BackgroundProstate cancer and schizophrenia
Torrey, E. F. (2006) · Urology · doi:10.1016/j.urology.2006.08.1061 · Cited by 40 · see citing works
Impact of mental health problems on case fatality in male cancer patients
Batty, G. D., Whitley, E., Galé, C. R., Osborn, D., Tynelius, P., & Rasmussen, F. E. (2012) · British Journal of Cancer · doi:10.1038/bjc.2012.150 · Cited by 39 · see citing works
“However, we are only aware of one study (Lawrence et al, 2000) that has directly examined cancer case fatality in psychiatric patients.”
BackgroundLin, J., McGlynn, K. A., Carter, C. A., Nations, J. A., Anderson, W. F., Shriver, C. D., & Zhu, K. (2016) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-16-0316 · Cited by 38 · see citing works
“Two other studies in the same area observed similar excess lung cancer mortality in people with psychiatric illnesses (1, 11).”
BackgroundLung cancer incidence in patients with schizophrenia: meta-analysis
Zhuo, C., Zhuang, H., Gao, X., & Triplett, P. T. (2019) · The British Journal of Psychiatry · doi:10.1192/bjp.2019.23 · Cited by 40 · see citing works
Disparities in Oral Cancer Survival among Mentally Ill Patients
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“However, the difference of medical care was not analyzed during these studies [6,7].”
BackgroundManderbacka, K., Arffman, M., Suvisaari, J., Ahlgrén-Rimpiläinen, A., Lumme, S., Keskimäki, I., & Pukkala, . (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.117.198952 · Cited by 36 · see citing works
Huang, H., Wang, Y., Hsieh, J., et al. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.10.029 · Cited by 37 · see citing works
“Research has shown that patients with severe mental illnesses, such as schizophrenia, are at greater risk of dying from cancer (Kisely et al., 2008; Lawrence et al., 2000).”
BackgroundComorbidity of mental and physical disorders
(2014) · Key Issues in Mental Health · doi:10.1159/isbn.978-3-318-02604-7 · Cited by 37 · see citing works
Dalton, S. O., Suppli, N. P., Ewertz, M., Kroman, N. T., Grassi, L. G., & Johansen, C. (2018) · The Breast · doi:10.1016/j.breast.2018.06.002 · Cited by 35 · see citing works
Excess mortality from breast cancer in female breast cancer patients with severe mental illness
Ahlgrén-Rimpiläinen, A., Arffman, M., Suvisaari, J., Manderbacka, K., Lumme, S., Keskimäki, I., Huovinen, R., & Pukkala, . (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112801 · Cited by 36 · see citing works
Wootten, J. C., Wiener, J. C., Blanchette, P., & Anderson, K. K. (2022) · Cancer Epidemiology · doi:10.1016/j.canep.2022.102233 · Cited by 36 · see citing works
Associations between DSM-IV mental disorders and subsequent self-reported diagnosis of cancer
O’Neill, S. M., Posada‐Villa, J., Medina‐Mora, M. E., Al-Hamzawi, A. O., Piazza, M., Tachimori, H., Hu, C., Lim, C. C. W., Bruffaerts, R., Lépine, J., et al. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2013.12.012 · Cited by 33 · see citing works
Kerrison, R., Jones, A., Peng, J., Price, G., Verne, J., Barley, E. A., & Lugton, C. (2023) · British Journal of Cancer · doi:10.1038/s41416-023-02249-3 · Cited by 38 · see citing works
Kisely, S., Alotiby, M. K. N., Protani, M. M., Soole, R., Arnautovska, U., & Siskind, D. (2023) · Psycho-Oncology · doi:10.1002/pon.6120 · Cited by 31 · see citing works
“ity for people with mental illness, demonstrating that social deprivation and disadvantage are not the sole determinants.(8,14)”
BackgroundEnd-of-Life Care for Veterans With Schizophrenia and Cancer
Ganzini, L. K., Socherman, R., Duckart, J. P., & Shores, M. M. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.7.725 · Cited by 30 · see citing works
Kisely, S. R., Ehrlich, C., Kendall, E. A., & Lawrence, D. M. (2015) · The Canadian Journal of Psychiatry · doi:10.1177/070674371506001105 · Cited by 30 · see citing works
Self-citationAlpert, A. B., Scout, N., Schabath, M. B., Adams, S., Obedin‐Maliver, J., & Safer, J. D. (2022) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_350175 · Cited by 31 · see citing works
In it together: Physical health and well-being for people with mental illness
Lawn, S. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867411432079 · Cited by 29 · see citing works
“However, mortality rates are significantly higher in people with mental illness (40% higher in males and 20% higher in females), most likely due to insufficient early detection, treatment and care; too little, too late (Lawrence et al., 2000).”
BackgroundSaha, S., Whiteford, H., & McGrath, J. J. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867413513341 · Cited by 27 · see citing works
“While Australian studies have shown conflicting findings with a differential mortality gap between psychiatric patients and the general population (Kisely et al., 2013; Lawrence et al., 2000a, 2000b), recent studies from other countries have confirmed a rise in mortality gaps.”
ResultBryngelson, A., Åsberg, M., Nygren, Å., Jensen, I. B., & Mittendorfer‐Rutz, E. (2013) · PLoS ONE · doi:10.1371/journal.pone.0067887 · Cited by 28 · see citing works
“[31–33]) The mechanisms involved might include inadequate detection of somatic disorders among patients with psychiatric disorders, delays in treatment seeking due to depression which might result in later detection of cancer, lifestyle factors, [7,31] as well as biological mechanisms such as dysfunctional HPA-axis, a…”
BackgroundPfrimmer, D. M. (2009) · The Journal of Continuing Education in Nursing · doi:10.3928/00220124-20090201-04 · Cited by 28 · see citing works
Perini, G., Grigoletti, L., Hanife, B., Biggeri, A., Tansella, M., & Amaddeo, F. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0765-0 · Cited by 26 · see citing works
“Regarding breast cancer mortality in our population, we did not confirm the results reported by other studies [24] of a slight increase in the risk of death for this cause in Table 3 continued”
ResultPsychiatric morbidity predicts perceived burn-specific health 1 year after a burn
Low, A., Dyster‐Aas, J., Willebrand, M., Ekselius, L., & Gerdin, B. (2012) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2011.12.001 · Cited by 25 · see citing works
“Psychiatric history, which is common in individuals who sustain major burns [13–15], has been shown to contribute to the outcome in other somatic conditions [16–22], and it is an”
BackgroundGlioma in Schizophrenia: Is the Risk Higher or Lower?
Gao, X., Mi, Y., Guo, N., Xu, H., Jiang, P., Zhang, R., Xu, L., & Gou, X. (2018) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2018.00289 · Cited by 26 · see citing works
The effect of locational disadvantage on hospital utilisation and outcomes in Western Australia
Brameld, K., & Holman, C. D. J. (2005) · Health & Place · doi:10.1016/j.healthplace.2005.08.014 · Cited by 25 · see citing works
Dombrovski, A. Y., & Rosenstock, J. B. (2004) · Current Opinion in Psychiatry · doi:10.1097/00001504-200411000-00018 · Cited by 25 · see citing works
Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy
Grassi, L. G., Stivanello, E., Murri, M. B., Perlangeli, V., Pandolfi, P., Carnevali, F., Caruso, R., Saponaro, A., Ferri, M., Sanza, M., et al. (2021) · Psycho-Oncology · doi:10.1002/pon.5805 · Cited by 26 · see citing works
Protani, M. M., Alotiby, M. K. N., Seth, R., Lawrence, D. M., Jordan, S. J., Logan, H., Kendall, B. J., Siskind, D. J., Sara, G. E., & Kisely, S. R. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000634 · Cited by 25 · see citing works
“This is despite the incidence of CRC in people with mental illness being the same or even lower than that of the general population (Lawrence et al., 2000; Kisely et al., 2008, 2013a, 2016).”
Self-citationStark, C. R., MacLeod, M., Hall, D. J., O’Brien, F., & Pelosi, A. J. (2003) · BMC Public Health · doi:10.1186/1471-2458-3-30 · Cited by 24 · see citing works
“Similarly, in Western Australia there was little difference in cancer incidence rates in people on a mental health service register compared to the general population, but a substantial increase in mortality [20].”
BackgroundMeta-analysis of the Correlation Between Schizophrenia and Breast Cancer
Zhang, X., Zhao, S., Feijiang, Y., Bo, C., Shifeng, Y., & Qihui, C. (2018) · Clinical Breast Cancer · doi:10.1016/j.clbc.2018.10.012 · Cited by 23 · see citing works
Exploring Cancer Screening in the Context of Unmet Mental Health Needs: A Participatory Pilot Study
Williams, A., Erb‐Downward, J., Bruzelius, E., O’Hara-Cicero, E., Maling, A., Machin, L., Viera-Delgado, M., Valera, P. A., Maysonet, N., & Weiss, E. S. (2013) · Progress in community health partnerships · doi:10.1353/cpr.2013.0027 · Cited by 22 · see citing works
Do users of mental health services lack access to general practitioner services?
Mai, Q., Holman, C. D. J., Sanfilippo, F. M., Emery, J. D., & Stewart, L. M. (2010) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03607.x · Cited by 23 · see citing works
- Authors
- Lawrence, D., D'Arcy, C., Holman, J., Jablensky, A. V., Threfall, T. J., & Fuller, S. A.
- Affiliations
- The University of Western Australia (AU)
- Government of Western Australia Department of Health (AU)
- Corresponding author
- Lawrence, D.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2000-05
- Volume
- 101
- Issue
- 5
- Pages
- 382-388
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W1986898046
- Cited by
- 174
- References
- 0
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 9 · 2022: 7 · 2021: 7 · 2020: 6 · 2019: 10 · 2018: 5 · 2017: 9 · 2016: 6 · 2015: 14 · 2014: 9 · 2013: 12 · 2012: 13
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- Department of Health, Government of Western Australia
- National Health and Medical Research Council
- National Medical Research Council
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- cancer mortality, mental illness, psychiatric patients, cancer incidence, case fatality rate, Western Australia, sex differences
- MeSH terms
- Australia, Mental Disorders, Catchment Area, Health, Female, Humans, Male, Mental Health Services, Neoplasms, Population Surveillance, Registries, Incidence, Survival Rate, Databases as Topic
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