Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French nationa
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ORIGINAL PAPER
Palliative and high‑intensity end‑of‑life care in schizophrenia patients with lung cancer: results from a French national population‑based study Marie Viprey1,2 · Vanessa Pauly1,3 · Sebastien Salas4 · Karine Baumstarck1 · Veronica Orleans3 · Pierre‑Michel Llorca5 · Christophe Lancon1,6 · Pascal Auquier1,2 · Laurent Boyer1,2,3 · Guillaume Fond1,2,3 Received: 30 June 2020 / Accepted: 20 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014–2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6 years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 [1.03;1.56]; p = 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 [0.41;0.70]; p
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