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Cancer mortality in patients with psychiatric diagnoses: a higher hazard of cancer death does not lead to a higher cumulative risk of dying from cancer

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Abstract

Purpose

Both increased as well as decreased cancer mortality among psychiatric patients has been reported, but competing death causes were not included in the analyses. This study aims to investigate whether observed cancer mortality in patients with psychiatric disorders might be biased by competing death causes.

Method

In this retrospective cohort study on data from the Psychiatric Case Register Middle Netherlands linked to the death register of Statistics Netherlands, the risk of cancer death among patients with schizophrenia (N = 4,590), bipolar disorder (N = 2,077), depression (N = 15,130) and their matched controls (N = 87,405) was analyzed using a competing risk model.

Results

Compared to controls, higher hazards of cancer death were found in patients with schizophrenia (HR = 1.61, 95 % CI 1.26–2.06), bipolar disorder (HR = 1.20, 95 % CI 0.81–1.79) and depression (HR = 1.26, 95 % CI 1.10–1.44). However, the HRs of death due to suicide and other death causes were more elevated. Consequently, among those who died, the 12-year cumulative risk of cancer death was significantly lower.

Conclusions

Our analysis shows that, compared to the general population, psychiatric patients are at higher risk of dying from cancer, provided that they survive the much more elevated risks of suicide and other death causes.

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Acknowledgments

We like to thank Statistics Netherlands (Centraal Bureau voor de Statistiek, CBS) for kindly providing the data necessary for the present analysis. Furthermore, we like to thank the participating psychiatric hospitals and services for providing all data for the database of the Psychiatric Case Register Middle Netherlands (PCR-MN). Structural funding of the Psychiatric Case Registers is provided by the participating psychiatric hospitals and services and by the Ministry of Health, Welfare and Sport (VWS). Representatives of the participating psychiatric hospitals and services co-decide on research priorities. Neither these participating psychiatric hospitals and services nor the VWS had a role in the study design, analysis, and interpretation of the data, in the writing of the present report, and in the decision to submit for publication.

Conflict of interest

All authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Psychological Medicine, University of Malaya, Malaya, Malaysia

    Ng Chong Guan & Nor Zuraida Zainal

  2. Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    Ng Chong Guan, Fabian Termorshuizen, Wijnand Laan, Hugo M. Smeets & Niek J. De Wit

  3. Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center (UMC) Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    René S. Kahn & Marco P. M. Boks

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  1. Ng Chong Guan
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  2. Fabian Termorshuizen
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Correspondence to Fabian Termorshuizen.

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Guan, N.C., Termorshuizen, F., Laan, W. et al. Cancer mortality in patients with psychiatric diagnoses: a higher hazard of cancer death does not lead to a higher cumulative risk of dying from cancer. Soc Psychiatry Psychiatr Epidemiol 48, 1289–1295 (2013). https://doi.org/10.1007/s00127-012-0612-8

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  • DOI: https://doi.org/10.1007/s00127-012-0612-8

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