Disparities in health care were identified in patients with cancer and schizophrenia receiving care at end of life compared with patients with cancer who do not have a mental illness, according to a study published in The Lancet Public Health.
In this population-based cohort study, researchers used data from the French national hospital database to select patients aged ≥15 years with schizophrenia (n=2474) and a matched control group of patients without a diagnosis of mental illness (n=9896) who received palliative care and who were hospitalized when they died from advanced cancer between January 1, 2013, and December 31, 2016. The researchers compared access to palliative care and indicators of high-intensity end-of-life care between groups. Adjustments were made for social deprivation, year of death, time from cancer diagnosis to death, metastases, comorbidities, and hospital type.
In an unmatched analysis, patients with schizophrenia and cancer were younger when they died compared with the matched control group (mean age at death, 63.6 years vs 71.8 years). In the matched analysis, patients with schizophrenia and cancer were more likely to receive palliative care but less likely to receive high-intensity end-of-life care compared with the matched control group. Multivariate analysis showed that compared with the matched control group, patients with schizophrenia and cancer had more frequent admissions to palliative care units in the last 31 days of life (adjusted odds ratio 1.61; 95% CI, 1.45-1.80; P <.0001). Patients with schizophrenia and cancer were also less likely than the matched control group to undergo chemotherapy, surgery, imaging, endoscopy, and blood transfusions. These patients were also less likely to be admitted to acute care units and less likely to die in intensive care units.
This study was limited by the use of data only from patients with advanced cancer who were hospitalized at the time of death. Data for psychiatric symptoms and use of psychotropic drugs were not available.
“The differences we identified between patients with schizophrenia and cancer and patients with cancer who do not have a diagnosis of mental illness suggest the existence of disparities in health and health care,” the researchers concluded. “Our findings underscore the need for better understanding of health inequalities so that effective interventions can be developed for this vulnerable population. Caring for an individual with schizophrenia and cancer requires knowledge and expertise in both oncology and psychiatry and might necessitate better training of health-care professionals and care coordination or integration.”
Fond G, Salas S, Pauly V, et al. End-of-life care among patients with schizophrenia and cancer: a population-based cohort study from the French national hospital database. Lancet Public Health. 2019;4(11):e583-e591.