title: Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer.
abstract: OBJECTIVE
  To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database.
  
  
  METHODS
  Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer.
  
  
  METHODS
  The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer-specific mortality were assessed using Cox proportional hazards regression and logistic regression.
  
  
  RESULTS
  Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR)=2.09, 95% confidence interval (CI)=1.86-2.35); and to have received no chemotherapy for Stage 3 cancer (ARR=1.63, 95% CI=1.49-1.79). The rate of overall mortality (hazard ratio (HR)=1.33, 95% CI=1.31-1.36) and colon cancer-specific mortality (HR=1.23, 95% CI=1.19-1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia.
  
  
  CONCLUSIONS
  Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders.
authors: Departments of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 775555, USA. jbaillar@utmb.edu
authors: Jacques
authors: J
authors: Baillargeon
authors: Yong-Fang
authors: YF
authors: Kuo
authors: Yu-Li
authors: YL
authors: Lin
authors: Mukaila A
authors: MA
authors: Raji
authors: Amanpal
authors: A
authors: Singh
authors: James S
authors: JS
authors: Goodwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003704:Dementia / Q000150:complications; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000150:complications; D012189:Retrospective Studies