Background and Hypothesis People with psychotic disorders have a higher risk of mortality following cancer diagnosis, compared to people without psychosis. The extent to which this disparity is influenced by differences in cancer-related treatment is currently unknown. We hypothesized that, following a cancer diagnosis, people with psychotic disorders were less likely to receive treatment and were at higher risk of death than those without psychosis. Study Design We constructed a retrospective cohort of cases of non-affective psychotic disorder (NAPD) and a general population comparison group, using Ontario Health (OH) administrative data. We identified cases of all cancers diagnosed between 1995 and 2019 and obtained information on cancer-related treatment and mortality. Cox proportional hazards models were used to compare the probability of having a consultation with an oncologist and receiving cancer-related treatment, adjusting for tumor site and stage. We also compared the rate of all-cause and cancer-related mortality between the two groups, adjusting for tumor site. Study Results Our analytic sample included 24 944 people diagnosed with any cancer. People with NAPD were less likely to receive treatment than people without psychosis (HR = 0.87, 95% CI = 0.82, 0.91). In addition, people with NAPD had a greater risk of death from any cause (HR = 1.68, 95% CI = 1.60, 1.76), compared to people without NAPD. Conclusions The lower likelihood of receiving cancer treatment reflects disparities in accessing cancer care for people with psychotic disorders, which may partially explain the higher mortality risk following cancer diagnosis. Future research should explore mediating factors in this relationship to identify targets for reducing health disparities.

中文翻译：

---

加拿大安大略省非情感性精神障碍患者癌症诊断后的治疗和死亡率：一项回顾性队列研究

背景和假设 与没有精神病的人相比，患有精神病的人在癌症诊断后死亡的风险更高。目前尚不清楚这种差异在多大程度上受到癌症相关治疗差异的影响。我们假设，在诊断出癌症后，患有精神病的人接受治疗的可能性较小，并且死亡风险比没有精神病的人更高。研究设计 我们利用安大略省卫生局 (OH) 的管理数据构建了一个非情感性精神病 (NAPD) 病例回顾性队列和一个一般人群比较组。我们确定了 1995 年至 2019 年间诊断的所有癌症病例，并获得了癌症相关治疗和死亡率的信息。使用 Cox 比例风险模型来比较咨询肿瘤科医生和接受癌症相关治疗的概率，并根据肿瘤部位和分期进行调整。我们还比较了两组之间的全因死亡率和癌症相关死亡率，并根据肿瘤部位进行了调整。研究结果 我们的分析样本包括 24,944 名被诊断患有任何癌症的人。患有 NAPD 的人比没有精神病的人接受治疗的可能性更低（HR = 0.87，95% CI = 0.82，0.91）。此外，与没有 NAPD 的人相比，患有 NAPD 的人全因死亡的风险更大（HR = 1.68，95% CI = 1.60，1.76）。结论 接受癌症治疗的可能性较低反映了精神病患者在获得癌症护理方面的差异，这可能部分解释了癌症诊断后死亡风险较高的原因。未来的研究应该探索这种关系中的中介因素，以确定减少健康差距的目标。