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Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French national population-based study

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Abstract

Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014–2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6 years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 [1.03;1.56]; p = 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 [0.41;0.70]; p < 0.0001; surgery 0.73 [0.59;0.90]; p < 0.01) than controls. Although the use and/or continuation of high-intensity end-of-life care is less important in schizophrenia patients with lung cancer, some findings suggest a loss of chance. Future studies should explore the expectations of patients with schizophrenia and lung cancer to define the optimal end-of-life care.

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Acknowledgements

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Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. CEReSS—Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D’Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France

    Marie Viprey, Vanessa Pauly, Karine Baumstarck, Christophe Lancon, Pascal Auquier, Laurent Boyer & Guillaume Fond

  2. Department of Epidemiology and Health Economics, APHM, Marseille, France

    Marie Viprey, Pascal Auquier, Laurent Boyer & Guillaume Fond

  3. Department of Medical Information, APHM, Marseille, France

    Vanessa Pauly, Veronica Orleans, Laurent Boyer & Guillaume Fond

  4. Department of Adult Oncology, APHM, Marseille, France

    Sebastien Salas

  5. CHU Clermont-Ferrand, Clermont-Ferrand, France

    Pierre-Michel Llorca

  6. Department of Psychiatry, APHM, Marseille, France

    Christophe Lancon

Authors
  1. Marie Viprey
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  2. Vanessa Pauly
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  3. Sebastien Salas
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  4. Karine Baumstarck
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  5. Veronica Orleans
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  6. Pierre-Michel Llorca
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  7. Christophe Lancon
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  8. Pascal Auquier
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  9. Laurent Boyer
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  10. Guillaume Fond
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Contributions

MV, GF and LB designed the study and wrote the first draft of the manuscript. VP and VO carried out the selection process and the statistical analyses. All authors have reviewed the final manuscript.

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Correspondence to Guillaume Fond.

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Data availability is not applicable to this article due to legal restrictions imposed by the French Agence technique de l'information sur l'hospitalisation (ATIH) which restricts access to data to French hospital staff.

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Viprey, M., Pauly, V., Salas, S. et al. Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French national population-based study. Eur Arch Psychiatry Clin Neurosci 271, 1571–1578 (2021). https://doi.org/10.1007/s00406-020-01186-z

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  • DOI: https://doi.org/10.1007/s00406-020-01186-z

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