465P - Oncological care needs of people with mental illness: A single institution experience in Australia

Background

This study evaluated the quality of oncological care of people with mental illness at an outer metropolitan centre.

Methods

A retrospective review of multidisciplinary team meetings (MDTs) was conducted and those with comorbid mental illness (“cases”) were identified. Demographic, psychiatric and oncological data were collected. Mental illness was stratified to 3 categories – Cat 1: mild affective disorders (uncomplicated depression/anxiety); Cat 2: complicated affective disorders (e.g. depression/anxiety with prior suicide attempt, hospitalisation and/or case management, substance use disorder and post-traumatic stress disorder); and Cat 3: severe mental illness (SMI) (e.g. bipolar affective disorder and schizophrenia). Patients without mental illness (“controls”) were randomly selected from the same tumour stream MDTs. Comparison between cases and controls was performed using Fisher’s exact test.

Results

Between 2021-2022, 853 patients were discussed at MDTs. 170 (20%) cases were identified, of whom 57%, 29% and 14% were in Cat 1, 2 and 3 respectively. Corresponding 170 controls were selected at random. Median age for cases was 65 vs. 71 for controls, p=0.03. No differences in sex and ethnicity were found. Cat 3 cases had the highest proportion receiving government financial aid (87%) vs. controls (57%) (Cat 1: 68%, Cat 2: 78%) p=0.001. Cat 3 cases also had the highest rates of ≥3 non-attendances to appointments (22%) vs. controls (7%) (Cat 1: 12%, Cat 2: 18%) p=0.006. Cases were found to have higher rates of metastatic disease at presentation (26% vs. 15% for controls, p=0.01). For patients offered active palliative treatment (n=80), cases had reduced adherence to the recommended treatment plan (70% vs. 91% for controls, p=0.03). Of those offered curative treatment (n=237), Cat 3 cases had the highest rates of cancer recurrence (33%) vs. controls (9%) (Cat 1: 12%, Cat 2: 18%) p=0.03.

Conclusions

Mental illness was associated with poorer cancer outcomes with increasing severity associated with even poorer outcomes, potentially reflecting higher rates of treatment non-adherence. This institutional study suggests that people with SMI have increased needs in navigating cancer care and highlights a need to examine this on a larger scale.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

Z.W. Wong: Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Other, Travel grant: Pfizer. Y. Antill: Financial Interests, Personal, Invited Speaker: GSK, MSD, AstraZeneca, Lilly, Eisai; Financial Interests, Institutional, Research Funding: AstraZeneca, MSD; Financial Interests, Personal, Advisory Board: GSK, MSD, AstraZeneca. All other authors have declared no conflicts of interest.