Do patients with schizophrenia receive state-of-the-art lung cancer therapy? A brief report.
OBJECTIVE
Patients with schizophrenia sometimes receive substandard medical care. This study explored such disparities among lung cancer patients with underlying schizophrenia.


METHODS
This retrospective study focused on patients with pre-existing schizophrenia (or in some instances schizoaffective disorder) and a lung cancer diagnosis made between 1980 and 2004. 'Disparity' was defined as a patient's having been prescribed less aggressive therapy for a potentially curable cancer based on state-of-the-art treatment standards for the time and for the cancer stage. Qualitative methods were used to assess healthcare providers' decision-making.


RESULTS
29 patients were included. The median age was 59 years; 38% were men. Twenty-three had non-small cell lung cancer and 6 small cell lung cancer; 17 had potentially curable cancers. Five of 17 had a 'disparity' in cancer care: (1) no cancer therapy was prescribed because of chronic obstructive pulmonary disease; (2) no cancer therapy was prescribed because of infection; (3) no chemotherapy was prescribed because the patient declined it; radiation was provided; (4) no chemotherapy was prescribed because of the patient's schizophrenia symptoms; radiation was administered; and (5) no surgery was performed because of disorientation from a lobotomy; radiation was prescribed. Comments from healthcare providers suggest reflection and ethical adjudication in decision-making.


CONCLUSIONS
Schizophrenia was never the sole reason for no cancer treatment in patients with potentially curable lung cancer. This study provides the impetus for others to begin to assess the effect of schizophrenia on lung cancer management in other healthcare settings.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Farrah J
FJ
Mateen
Aminah
A
Jatoi
Timothy W
TW
Lineberry
Dawn
D
Aranguren
Edward T
ET
Creagan
Gary A
GA
Croghan
James R
JR
Jett
Randolph S
RS
Marks
Julian R
JR
Molina
Ronald L
RL
Richardson
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D015897:Comorbidity; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D005260:Female; D054625:Healthcare Disparities / Q000941:ethics*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis* / Q000453:epidemiology; D012565:Schizophrenic Psychology