Online Program

Adjuvant radiation therapy in breast cancer patients: The burden of preexisting schizophrenia

Sunday, November 3, 2013

Lauren Davies, BA, Department of Surgery, Saint Louis University, St. Louis, MO
Kashif Abdullah, MD, Department of Surgery, Saint Louis University, St. Louis, MO
Radhakrishna Janardhan, MD, Department of Surgery, Saint Louis University, St. Louis, MO
Mark Hwang, MD, Department of Surgery, Saint Louis University, St. Louis, MO
Michael Farasatpour, MD, Department of Surgery, Saint Louis, St. Louis, MO
Julie A. Margenthaler, MD, Department of Surgery, Washington University, St. Louis, MO
Katherine S. Virgo, PhD, MBA, Health Services Research, American Cancer Society, Atlanta, GA
Frank E. Johnson, MD, Deptartment of Surgery, Saint Louis University, Saint Louis, MO
Purpose: Schizophrenia affects about 1% of subjects in all populations studied thus far. It impairs the delivery of medical care and degrades the clinical course of patients with unrelated physical disorders. We hypothesized that patients with schizophrenia who later develop breast cancer would fare poorly when adjuvant radiation therapy (ART) is clinically indicated as part of breast-conserving treatment. Methods: We searched Patient Treatment File (PTF), the national inpatient computer database of the Department of Veterans Affairs (DVA), to identify patients with schizophrenia who subsequently developed breast cancer and were treated in DVA Medical Centers (DVAMCs) from 1999 to 2005. Chart-based clinical information from the DVAMCs where the patients had been treated supplemented PTF data. Results: 56 patients met our criteria and were considered potentially evaluable. We found data regarding medication compliance in 50 of the 56 patients. 26 of the 50 patients (52%) refused to take medications; 15 of the 50 (30%) declined after initially taking the medication; 11 of the 50 (22%) refused to take medication at any time for unspecified reasons. 42 patients had preexisting schizophrenia, later developed breast cancer, and were considered to be candidates for ART. There were 31 women (74%) and 11 men (26%). 27 of the 42 subjects had records specifying TNM stage; 18 of the 42 (67%) had TNM stages III-IV. We found data regarding compliance with indicated medical therapies for previous disorders in 31 subjects; 24 (77%) had previously been noncompliant with care. We found data regarding delay in treatment for previous physical disorders in 39 subjects; 20 (51%) had previously delayed medically indicated treatment. We found data about the decision to recommend ART in 37; only 23 (26%) were offered ART and 3 of those 23 (13%) refused it. Conclusion: The burden of schizophrenia in patients diagnosed with breast cancer affects patients who could benefit from ART. Breast-conserving multimodality treatment with ART is frequently not appropriate; radical surgery is often preferable.

Learning Areas:

Clinical medicine applied in public health
Public health or related research

Learning Objectives:
Describe the burden of schizophrenia in breast cancer patients.

Keyword(s): Breast Cancer, Mental Illness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Because I am a surgical oncologist and I encounter 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.