title: Psychiatric illness delays diagnosis of esophageal cancer.
abstract: Evidence suggests that patients with psychiatric illnesses may be more likely to experience a delay in diagnosis of coexisting cancer. The association between psychiatric illness and timely diagnosis and survival in patients with esophageal cancer has not been studied. The specific aim of this retrospective cohort study was to determine the impact of coexisting psychiatric illness on time to diagnosis, disease stage and survival in patients with esophageal cancer. All patients with a diagnosis of esophageal cancer between 1989 and 2003 at the Portland Veteran's Administration hospital were identified by ICD-9 code. One hundred and sixty patients were identified: 52 patients had one or more DSM-IV diagnoses, and 108 patients had no DSM-IV diagnosis. Electronic charts were reviewed beginning from the first recorded encounter for all patients and clinical and demographic data were collected. The association between psychiatric illness and time to diagnosis of esophageal cancer and survival was studied using Cox proportional hazard models. Groups were similar in age, ethnicity, body mass index, and history of tobacco and alcohol use. Psychiatric illness was associated with delayed diagnosis (median time from alarm symptoms to diagnosis 90 days vs. 35 days in patients with and without psychiatric illness, respectively, P < 0.001) and the presence of advanced disease at the time of diagnosis (37% vs. 18% of patients with and without psychiatric illness, respectively, P= 0.009). In multivariate analysis, psychiatric illness and depression were independent predictors for delayed diagnosis (hazard ratios 0.605 and 0.622, respectively, hazard ratio < 1 indicating longer time to diagnosis). Dementia was an independent risk factor for worse survival (hazard ratio 2.984). Finally, psychiatric illness was associated with a decreased likelihood of receiving surgical therapy. Psychiatric illness is a risk factor for delayed diagnosis, a diagnosis of advanced cancer, and a lower likelihood of receiving surgical therapy in patients with esophageal cancer. Dementia is associated with worse survival in these patients. These findings emphasize the importance of prompt evaluation of foregut symptoms in patients with psychiatric illness.
authors.affiliation: Departments of Surgery and Radiation Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: O'Rourke
authors.forename: B S
authors.initials: BS
authors.lastname: Diggs
authors.forename: D H
authors.initials: DH
authors.lastname: Spight
authors.forename: J
authors.initials: J
authors.lastname: Robinson
authors.forename: K A
authors.initials: KA
authors.lastname: Elder
authors.forename: J
authors.initials: J
authors.lastname: Andrus
authors.forename: C R
authors.initials: CR
authors.lastname: Thomas
authors.forename: J G
authors.initials: JG
authors.lastname: Hunter
authors.forename: B A
authors.initials: BA
authors.lastname: Jobe
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors