Effect of Mental Disorders on Diagnosis, Treatment, and Survival of Older Adults with Colon Cancer
Article first published online: 7 JUL 2011
© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 59, Issue 7, pages 1268–1273, July 2011
How to Cite
Baillargeon, J., Kuo, Y.-F., Lin, Y.-L., Raji, M. A., Singh, A. and Goodwin, J. S. (2011), Effect of Mental Disorders on Diagnosis, Treatment, and Survival of Older Adults with Colon Cancer. Journal of the American Geriatrics Society, 59: 1268–1273. doi: 10.1111/j.1532-5415.2011.03481.x
- Issue published online: 13 JUL 2011
- Article first published online: 7 JUL 2011
- colon cancer;
- mental health;
- access to care
OBJECTIVES: To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer.
DESIGN: Retrospective cohort study.
SETTING: The Surveillance, Epidemiology and End Results (SEER)–Medicare linked database.
PARTICIPANTS: Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer.
MEASUREMENTS: The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer-specific mortality were assessed using Cox proportional hazards regression and logistic regression.
RESULTS: Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR)=2.09, 95% confidence interval (CI)=1.86–2.35); and to have received no chemotherapy for Stage 3 cancer (ARR=1.63, 95% CI=1.49–1.79). The rate of overall mortality (hazard ratio (HR)=1.33, 95% CI=1.31–1.36) and colon cancer-specific mortality (HR=1.23, 95% CI=1.19–1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia.
CONCLUSION: Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders.