236889 Metastatic breast cancer in schizophrenic patients

Tuesday, November 1, 2011

Aaron Meyer, BA , Department of Surgery, Saint Louis University, Saint Louis, MO
Radhakrishna Janardhan, MD , Department of Surgery, Saint Louis VAMC, St. Louis, MO
Mark Hwang, BA , Department of Surgery, Saint Louis University, Saint Louis, MO
Julie Margenthaler, MD , Department of Surgery, Washington University, St. Louis, MO
Katherine S. Virgo, PhD, MBA , Managing Director, Health Services Research/ Intramural Research, American Cancer Society National Home Office, Atlanta, GA
Mishel Farasatpour, BS , Department of Surgery, Saint Louis University, Saint Louis, MO
Frank E. Johnson, MD , Dept. of Surgery, Saint Louis University & Saint Louis VAMC, Saint Louis, MO
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.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
Explain how schizophrenia affects patients with breast cancer.

Keywords: Breast Cancer, Mental Illness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I treat schizophrenic patients with breast cancer.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.