Purpose Limited data are available on the survival of patients with breast cancer with preexisting mental illness, and elderly women are of special interest because they experience the highest incidence of breast cancer. Therefore, we compared all-cause and breast cancer-specific mortality for elderly patients with breast cancer with and without mental illness. Methods A retrospective cohort study was conducted by using SEER-Medicare data, including 19,028 women ≥ 68 years of age who were diagnosed with stage I to IIIa breast cancer in the United States from 2005 to 2007. Patients were classified as having severe mental illness if an International Classification of Diseases, Ninth Edition, Clinical Modification code for bipolar disorder, schizophrenia, or other psychotic disorder was recorded on at least one inpatient or two outpatient claims during the 3 years before breast cancer diagnosis. Patients were followed for up to 5 years after breast cancer diagnosis to assess survival outcomes, which were then compared with those of patients without mental illness. Results Nearly 3% of patients had preexisting severe mental illness. We observed a two-fold increase in the all-cause mortality hazard between patients with severe mental illness compared with those without mental illness after adjusting for age, income, race, ethnicity, geographic location, and marital status (adjusted hazard ratio, 2.19; 95% CI, 1.84 to 2.60). A 20% increase in breast cancer-specific mortality hazard was observed, but the association was not significant (adjusted hazard ratio, 1.20; 95% CI, 0.82 to 1.74). Patients with severe mental illness were more likely to be diagnosed with advanced breast cancer and aggressive tumor characteristics. They also had increased tobacco use and more comorbidities. Conclusion Patients with severe mental illness may need assistance with coordinating medical services.

中文翻译：

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既往精神疾病对老年乳腺癌患者全因死亡率和乳腺癌特异性死亡率的影响

目的 关于既往患有精神疾病的乳腺癌患者的生存数据有限，老年妇女尤其受到关注，因为她们的乳腺癌发病率最高。因此，我们比较了患有精神疾病和不患有精神疾病的老年乳腺癌患者的全因死亡率和乳腺癌特异性死亡率。方法 使用 SEER-Medicare 数据进行回顾性队列研究，包括 2005 年至 2007 年在美国被诊断为 I 至 IIIa 期乳腺癌的 19,028 名≥ 68 岁女性。国际疾病分类，第九版，双相情感障碍、精神分裂症的临床修改代码，在乳腺癌诊断前的 3 年内，至少有一次住院或两次门诊索赔记录了患有或其他精神障碍。在乳腺癌诊断后对患者进行长达 5 年的随访以评估生存结果，然后将其与没有精神疾病的患者进行比较。结果 近 3% 的患者预先存在严重的精神疾病。我们观察到，在调整年龄、收入、种族、民族、地理位置和婚姻状况后，与没有精神疾病的患者相比，患有严重精神疾病的患者的全因死亡风险增加了两倍（调整后的风险比为 2.19； 95% 置信区间，1.84 至 2.60）。观察到乳腺癌特异性死亡率风险增加了 20%，但相关性不显着（调整后的风险比，1.20；95% CI，0.82 至 1.74）。患有严重精神疾病的患者更有可能被诊断出患有晚期乳腺癌和侵袭性肿瘤特征。他们还增加了烟草使用和更多的合并症。结论 严重精神疾病患者可能需要协助协调医疗服务。