Patients with psychiatric disorders are diagnosed with esophageal cancer much later and at a more advanced stage than patients with no psychiatric diagnosis, according to a study conducted by researchers in the Oregon Health & Science University Digestive Health Center. The finding is significant, according to the study's principal investigator, Blair Jobe, M.D., because life and death for cancer patients is all about early detection and intervention.
This study was prompted by observations made in Jobe's clinical practice. He and colleagues wished to determine whether psychiatric illness represented an independent risk factor for delay in diagnosis and advanced disease at the time the patient first displayed symptoms.
"Research has shown that initial diagnosis and management of a disease process is more difficult in patients with a psychiatric disorder," explained Jobe, an assistant professor of surgery in the OHSU School of Medicine, Portland Veterans Affairs Medical Center (PVAMC). "Although a delay in diagnosis of esophageal cancer did not appear to result in a reduction of overall survival - a reflection of the lethality of esophageal cancer - the relationship between psychiatric disorders and esophageal cancer is very important to heed, especially as we improve in our ability to make the diagnosis in the early, more curable stages."
In this study, Jobe and colleagues reviewed the medical records of 160 veterans with esophageal cancer seen at the PVAMC during a 13-year period. Fifty-two of the veterans had been diagnosed with a psychiatric disorder prior to their cancer diagnosis; the remaining 108 patients had no psychiatric disorder prior to diagnosis. Psychiatric disorders reported include depression, dementia, anxiety, schizophrenia, personality disorder and post-traumatic stress disorder.
The researchers found that no single risk factor contributed to a delay in diagnosis. Rather, they suggest that one or more variables may play a role, including provider bias or lack of awareness, patients' inability to articulate symptoms, patients' socio-economic status or their lack of access to care. Research to determine exactly which of these variables play a role and how to best rectify them is ongoing at OHSU.
"From here it will be important to understand why patients with psychiatric illness have a delay and eliminate it," said Jobe, also a member of the OHSU Cancer Institute. "In the meantime, our findings emphasize the importance of prompt evaluation of symptoms in all patient populations."
ABOUT ESOPHAGEAL CANCER
The National Cancer Institute estimates 13,200 Americans will be diagnosed with esophageal cancer this year and 12,500 will die of the malignancy. Of the new cases, 9,200 will occur in men and 3,100 will occur in women.
An estimated 25 million Americans have some form of esophageal disease, the most common of which is gastroesophageal reflux disease (GERD). Patients with severe GERD have a 40 times greater risk of developing esophageal cancer than those without GERD symptoms, similar to the risk of developing lung cancer for a cigarette smoker. However, for any one particular individual with GERD, the risk of esophageal cancers is quite low.
ABOUT PSYCHIATRIC DISORDERS
Approximately 44 million Americans have a psychiatric disorder, according to the National Institute of Mental Illness of the National Institutes of Health. Mental health disorders account for four of the top 10 causes of disability in established market economies, such as the US, worldwide, and include: major depression (also called clinical depression), manic depression (also called bipolar disorder), schizophrenia, and obsessive-compulsive disorder.
Approximately 18.8 million American adults will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year. Many of them will be unnecessarily incapacitated for weeks or months because their illness is left untreated.