Mental health problems and colon cancer: a double-whammy that leads to poor cancer outcomes

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We know that mental health problems often go hand in hand with other physical health complaints. Older adults with cancer and mental health issues are especially vulnerable as they tend to suffer from behavioural, socio-economic and biological changes that act as barriers to effective healthcare.

This retrospective cohort study conducted by researchers from the University of Texas set out to evaluate the extent to which pre-existing mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer.

The study retrospectively assessed 80,670 people aged 67 and over, for a 12 year period. A range of psychiatric disorders were studied including mood disorders, psychotic disorders, dementia, substance misuse and other mental health conditions. Patients diagnosed with a mental health problem up to 2 years prior to their cancer diagnosis were included.

Outcomes included the cancer stage at diagnosis, cancer diagnosis at autopsy, not receiving treatment (all stages of colon cancer), not receiving chemotherapy for stage 3 colon cancer, mortality from all causes and colon cancer specific mortality.

Here’s what they found:

  • 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)
    • 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

The authors concluded:

Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders.

Baillargeon J, Kuo YF, Lin YL, Raji MA, Singh A, Goodwin JS. Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer. J Am Geriatr Soc. 2011 Jul;59(7):1268-73. doi: 10.1111/j.1532-5415.2011.03481.x. Epub 2011 Jul 7. [PubMed abstract]

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