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Delay in the Diagnosis of Breast and Colorectal Cancer in People With Severe Mental Disorders

Céspedes, Pedro RN; Sánchez-Martínez, Vanessa PhD, RN; Lera-Calatayud, Guillem PhD, MD; Vila-Candel, Rafael PhD, RM; Cauli, Omar PhD, MD; Buigues, Cristina PhD, RN

doi: 10.1097/NCC.0000000000000727
Article: PDF Only

Background People with severe mental disorders have a worse cancer prognosis, with higher mortality rates than the general population, and this could be partially attributed to a later detection. Breast cancer and colorectal cancer have mass population screenings in Spain, but the influence in early diagnosis is unknown in persons with severe mental disorders.

Objective To compare the severity of breast and colorectal cancers at diagnosis in people with and without mental disorders.

Methods This was an observational, retrospective, case-control study with 1:2 matching performed in Eastern Spain. Data were retrieved for analysis from electronic medical records.

Results The study included 111 oncology patients (75 with breast cancer and 36 with colorectal cancer). Individuals with mental disorders had a significantly higher (P = .002) relative risk (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.60–9.65) to be diagnosed with an advanced tumor stage (clinical stages IIIA, IIIB, IIIC, and IV), for both breast and colorectal cancers when analyzed separately. The variables associated with advanced cancer at the time of diagnosis were the presence of a previous mental disorder (OR, 4.67; 95% CI, 1.73–12.61) and older age (OR, 1.08; 95% CI, 1.02–1.14).

Conclusions Individuals with severe mental disorders showed a higher risk of being diagnosed with breast and colorectal cancers at advanced stages.

Implications for Practice: Cancer screening for earlier detection and intervention in people with severe mental disorders needs improvement. Mental health nurses, screening nurses, and oncology nurses could serve an essential role in increasing the screening adherence of this group of individuals.

Author Affiliations: Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia (Mr Céspedes and Drs Sánchez-Martínez, Cauli, and Buigues); Mental Health Outpatients Clinic of Sueca (Dr Lera-Calatayud); and Department of Obstetrics and Gynecology, La Ribera University Hospital, and Faculty of Nursing, Catholic University of Valencia “San Vicente Mártir” (Dr Vila-Candel), Valencia, Spain.

P.C. and V.S.-M. contributed equally to this work.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Vanessa Sánchez-Martínez, PhD, RN, Faculty of Nursing and Chiropody, C/Jaume Roig s/n, 46010 Valencia, Spain (

Accepted for publication March 25, 2019.

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