精神分裂病患的罹癌風險需要更多關注


  June 26, 2009 — 根據一項線上發表於6月22日癌症期刊的新研究結果,癌症是精神分裂病患的第二常見死因,特別是乳癌與肺癌,這些病患罹癌風險比一般大眾高出50%。這些研究結果顯示,應該付出更多關心來加強精神分裂病患的癌症預防與早期發現。
  
  主要作者來自法國Reims大學精神科的Frederic Limosin醫師向Medscpe精神醫學表示,癌症是我們精神分裂病患第二常見的死因,介於自殺與心血管疾病之間。
  
  【男性易罹患肺癌•女性易罹患乳癌】
  精神分裂症與早死發生率增加有關,部分是因為這些病患自殺機率高。然而,單單自殺並不能解釋精神分裂病患生命周期較短。部分研究已經指出,癌症死亡率可能扮演部分角色,但其他研究數據顯示,精神分裂病患相較於一般大眾,罹患癌症機率實際上是比較低的。
  
  為了更精確地確認精神分裂病患的癌症盛行率,Limosin醫師與其同事們前瞻性地針對3,470位精神分裂病患進行研究,並且從1993年起追蹤癌症發生率。研究者們也想要找出可能協助預測精神分裂病患較容易罹癌的危險因子。
  
  研究者們發現,476位(14%)病患在11年的研究期間中死亡,這個死亡率是一般大眾的4倍。74位病患死於癌症,成為僅次於自殺的第二常見死因。
  
  不論何種癌症,相較於一般男性,精神分裂男性因為癌症死亡的機率高出1.4倍,作者們指出,但是這個傾向並未達到統計上顯著差異。相較於一般女性,精神分裂女性因為癌症死亡的機率高出1.9倍(95%信賴區間為1.4-2.8),這個差異達到統計上顯著水準。
  
  Limosin醫師表示,最常造成死亡的癌症,在男性為肺癌,女性則是乳癌。在我們的樣本中,男性精神分裂病患因為肺癌死亡的風險顯著地比一般大眾高(標準化死亡比值[SMR]為2.2;95% CI為1.6-3.3),這個比值與我們的樣本中,吸菸者頻率較高相符。在這個試驗族群中,吸菸的比例比一般大眾高(56.3%相較於33.0%)。
  
  對女性的精神分裂病患而言,因為乳癌死亡的風險顯著地比一般大眾高(SMR為2.8;95% CI為1.6-4.9)。
  
  作者們推測,這些發現可能的解釋包括因為比較不注意症狀而延遲診斷;精神分裂病患較不容易因為最佳治療而獲益;以及對治療的順從性低。
  
  Limosin醫師與其合作夥伴表示,其他的研究應該進一步檢驗罹患精神分裂病患的罹癌率,且應該進一步地找出這些病患的罹癌特性。
  
  Limosin醫師的結論是,我們的結果強調,必須有精神科醫師以及一般執業醫師來評估精神分裂病患罹癌風險(特別是吸菸的患者),以及儘可能及早偵測癌症發生。
  
  【精神科醫師呼籲多關注癌症風險】
  來自以色列耶路撒冷衛生部門精神健康服務的Gilad Gal博士與Itzhak Levav醫師也針對精神分裂患者的癌症風險進行研究。他們同意Limosin醫師有關於其研究的臨床意義。
  
  Gilad Gal博士與Itzhak Levav醫師在電子郵件回應中向Medscape精神醫學表示,這項研究喚起精神科醫師應該對病患的生理照護上多加關注,不論是在醫院或是社區。
  
  然而,他們也指出,在研究癌症與精神分裂症之間的關係,發病率將會是比較好的選擇。
  
  Levav醫師表示,但是如果這項研究所宣稱的目的只是要確認死亡風險,則這項研究提供給我一個構想良好的快速檢閱:這告訴我們健康服務端的管道差異、可獲得性、特性與照護品質,在病患端的自我照護、以及對治療的順從性都是非常重要的。
  
  這項研究由健康走向與醫療研究基金會經費贊助。作者們表示無相關資金上的往來。
  

Cancer Risk in Schizophrenia Needs More Attention

By Janis Kelly
Medscape Medical News

June 26, 2009 — Cancers, especially breast cancer and lung cancer, are the second most common cause of death in people with schizophrenia, whose risk for cancer death is 50% higher than that of the general population, according to a new study published online June 22 in Cancer. The results suggest that extra efforts should be made to improve cancer prevention and early detection in patients with schizophrenia.

"Cancer was the second most common cause of death in our sample of schizophrenic patients, after suicide and before cardiovascular disease," lead author Frederic Limosin, MD, PhD, from the department of psychiatry at the University of Reims, in France, told Medscape Psychiatry.

Lung Cancer in Men, Breast Cancer in Women

Schizophrenia is associated with an increased incidence of premature death, in part due to a high rate of suicide among individuals with the disease. However, suicide alone does not account for the shortened life expectancy seen in schizophrenia patients. Some studies have indicated that cancer mortality may play a role, but other data suggest that cancer rates are actually lower among individuals with schizophrenia compared with the general population.

To more precisely determine the prevalence of cancer in patients with schizophrenia, Dr. Limosin and colleagues prospectively studied 3470 patients with schizophrenia and tracked cancer incidence beginning in 1993. The investigators also sought to identify characteristics that might help predict which schizophrenic patients are likely to develop cancer.

The researchers found that 476 (14%) patients died from all causes during the 11 years of the study, a death rate that is 4-fold higher than in the general population. Seventy-four patients died of cancer, making it the second most frequent cause of death behind suicide.

For all cancers, the deaths by cancer were 1.4-fold more frequent in schizophrenic men than in the male general population, the authors report, but this tendency did not reach statistical significance. Deaths by cancer were 1.9-fold more frequent in schizophrenic women than in the female general population (95% CI, 1.4 – 2.8), which was statistically significant.

The most common causes of cancer death were lung cancer in men and breast cancer in women. "The risk of death due to lung cancer in male patients with schizophrenia in our sample was significantly higher than that in the general population (standardized mortality ratio [SMR], 2.2; 95% CI, 1.6 – 3.3), a result in accordance with the high frequency of smokers in our sample," Dr. Limosin said. The proportion of patients who were smokers was significantly higher in the study population than in the general population (56.3% vs 33.0%).?

In female schizophrenic patients, the risk for death due to breast cancer was significantly higher than in the general population (SMR, 2.8; 95%, CI 1.6 – 4.9).

Possible explanations for these findings include a delay in diagnosis due to patients paying less attention to symptoms; the difficulty for schizophrenic patients to benefit from optimum treatment; and less compliance with treatment, the authors speculate.

Dr. Limosin and his collaborators noted that additional studies should further examine cancer rates in individuals with schizophrenia and should better define the characteristics of tumors that arise in these patients.

"Our results emphasize the necessity for psychiatrists, but also general practitioners, to assess risk factors of cancer in schizophrenic patients (especially smoking) and to detect cancer occurrence as early as possible," Dr. Limosin concluded.

Psychiatrists Urged to Pay More Attention to Cancer Risk

Gilad Gal, PhD, and Itzhak Levav, MD, from the Mental Health Services in the Ministry of Health, in Jerusalem, Israel, have also studied the risk for cancer among patients with schizophrenia. They concur with Dr. Limosin about the clinical implications of his study.

"The study calls upon psychiatrists to be more aware with regard to the physical care of the patients, whether hospitalized or in the community," Drs. Gal and Levav told Medscape Psychiatry in emailed correspondence.

However, they also point out that morbidity data would have been preferable for investigating the association between cancer and schizophrenia.

"But if the stated objective of the study is to check solely the mortality risk — then the study appears to us in a quick review that is well conceived: it suggests that issues of differential access, availability, stigma, and of quality of care on the part of the services are paramount, as well as deficient self-care and adherence to treatment on the part of the patient," Dr. Levav said.

This study was supported by the General Direction of Health and the Foundation for Medical Research grants. The authors report no conflict of interest.

Cancer. Published online June 22, 2009.

    
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