Evidence suggests that patients with psychiatric illnesses may be more likely to experience a delay in diagnosis of coexisting cancer.
The association between psychiatric illness and timely diagnosis and survival in patients with esophageal cancer has not been studied.
Dr O'Rourke and colleagues from the USA undertook a retrospective cohort study in 160 patients with a diagnosis of esophageal cancer between 1989 and 2003.
The research team determined the impact of coexisting psychiatric illness on time to diagnosis, disease stage and survival in patients with esophageal cancer.
|Median time to diagnosis was 90 days with psychiatric illness|
|Diseases of the Esophagus|
All patients with a diagnosis of esophageal cancer at the Portland Veteran's Administration hospital were identified by ICD-9 code.
Of the patients identified, 52 had one or more DSM-IV diagnoses, and 108 patients had no DSM-IV diagnosis.
The team reviewed electronic charts beginning from the first recorded encounter for all patients.
The researchers collected clinical and demographic data.
The association between psychiatric illness and time to diagnosis of esophageal cancer and survival was studied using Cox proportional hazard models.
Groups were similar in age, ethnicity, body mass index, and history of tobacco and alcohol use.
The researchers found that psychiatric illness was associated with delayed diagnosis.
The median time from alarm symptoms to diagnosis was 90 days vs 35 days in patients with and without psychiatric illness, respectively.
The team noted that the presence of advanced disease at the time of diagnosis was associated with delayed diagnosis.
The research team observed advanced disease in 37% vs 18% of patients with and without psychiatric illness, respectively.
In multivariate analysis, psychiatric illness and depression were independent predictors for delayed diagnosis.
Dementia was an independent risk factor for worse survival.
Finally, psychiatric illness was associated with a decreased likelihood of receiving surgical therapy.
Dr O'Rourke's team concluded, "Psychiatric illness is a risk factor for delayed diagnosis, a diagnosis of advanced cancer, and a lower likelihood of receiving surgical therapy in patients with esophageal cancer."
"Dementia is associated with worse survival in these patients."
"These findings emphasize the importance of prompt evaluation of foregut symptoms in patients with psychiatric illness."