Metastatic breast cancer in schizophrenic patients

Introduction: Breast cancer is a major world-wide public health problem. The median survival duration for patients with metastatic breast cancer (MBC) is 2-3 years. Approximately 1% of populations worldwide have schizophrenia, also a major public health problem. Schizophrenic patients often have difficulty with daily functioning and social interaction. We evaluated how schizophrenic patients fare when diagnosed with MBC. Methods: We queried national Department of Veterans Affairs (DVA) datasets using computer codes for a pre-existing diagnosis of schizophrenia and a later diagnosis of breast carcinoma. We requested chart-based data concerning the identified subjects. We applied previously determined inclusion and exclusion criteria to select evaluable patients from the medical records, then extracted demographic details and data concerning the treatment course in each subject. Results: There were 10 patients who had MBC at initial diagnosis and 7 who developed MBC after prior curative-intent treatment. Of these 17, 3 denied their diagnosis. 2 patients refused all therapy. 10 did not comply with recommended management. 5 harmed or threatened physicians, other caregivers, or themselves. Conclusion: This is the first report on this topic, to our knowledge. The burden of schizophrenia in patients with MBC is very large and under-recognized. Such patients often fail to understand the nature of their illnesses. They often do not accept palliative cancer treatment. Many do not comply with therapy, once initiated. They often exhibit behaviors that are detrimental to themselves or others. Formal psychiatric consultation is warranted in such patients. Many detrimental behaviors can be predicted reliably by history alone.