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Diagnosis and treatment delays among elderly breast cancer patients with pre-existing mental illness

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to compare diagnosis and treatment delays in elderly breast cancer patients with and without pre-existing mental illness.

Methods

A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results—Medicare data including 16,636 women 68+ years, who were diagnosed with stage I–IIIa breast cancer in the United States from 2005 to 2007. Mental illness was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes recorded on inpatient and outpatient claims during the 3 years prior to breast cancer diagnosis. Patients were classified as having no mental illness, anxiety, depression, anxiety and depression, or severe mental illness (bipolar disorder, schizophrenia, and other psychotic disorder). Multivariable binomial regression was used to assess the association between mental illness and delays of ≥60 and ≥90 days after adjustment for confounders.

Results

Patients with comorbid anxiety and depression had an increased risk for diagnosis delay of ≥90 days from symptom recognition (RR 1.11; 95% CI 1.00, 1.23), and those with severe mental illness had an increased risk for initial treatment delay of ≥60 days from diagnosis (RR 1.36; 95% CI 1.06, 1.74). Patients with any mental illness experienced an increased risk for adjuvant chemotherapy delay of ≥90 days from last operation (RR 1.13; 95% CI 1.01, 1.26) and each category of mental illness, except depression, showed a non-significant trend for this association.

Conclusion

Breast cancer patients with mental illness should be closely managed by a cross-functional care team, including a psychiatrist, a primary care physician, and an oncologist, to ensure adequate care is received within an appropriate timeframe.

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Authors and Affiliations

  1. Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA

    Kristy Iglay, Melissa L. Santorelli, George G. Rhoads & Kitaw Demissie

  2. Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA

    Kim M. Hirshfield, Yong Lin & Kitaw Demissie

  3. Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA

    Kim M. Hirshfield & Jill M. Williams

  4. Department of Biostatistics, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA

    Yong Lin

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  1. Kristy Iglay
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Correspondence to Melissa L. Santorelli.

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Conflict of interest

Dr. Iglay disclosed employment with Merck & Co., Inc. and Dr. Williams disclosed a consultant/advisory role with Pfizer.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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Iglay, K., Santorelli, M.L., Hirshfield, K.M. et al. Diagnosis and treatment delays among elderly breast cancer patients with pre-existing mental illness. Breast Cancer Res Treat 166, 267–275 (2017). https://doi.org/10.1007/s10549-017-4399-x

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