Pre-diagnostic investigations and cancer diagnosis via emergency presentation among patients with severe mental illness or learning disabilities
1
Univeristy College London, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Patients with severe mental illness (SMI) or learning disabilities (LD) often experience barriers in accessing timely cancer diagnosis, but population-based evidence is scant. We investigated variations in the likelihood of pre-diagnostic investigations for cancer and the risk of cancer diagnosis following emergency presentation (EP) by SMI or LD status.
METHODS:
We used linked CPRD Gold primary care, secondary care and cancer registration data of patients diagnosed with lung, colon, rectum, upper gastrointestinal, pancreatic and hepatobiliary, breast or prostate cancers in England in 2010-2018. We identified patients with SMI (bipolar disorder, schizophrenia or other psychoses) or with learning disability from CPRD records. Using multivariable logistic regression, we explored associations between SMI conditions or LD and i) diagnostic investigations 31-182 days (1-6 months) pre-cancer diagnosis and ii) cancer diagnosis following EP, adjusting for socio-demographic, clinical and healthcare factors.
RESULTS:
Among the 93,363 cancer patients, 1.6% had a record of pre-existing SMI, while 0.3% had a record of LD. Around 16% of patients underwent diagnostic investigations 1-6 months pre-diagnosis. Schizophrenia was associated with reduced odds of investigations 1-6 months pre-diagnosis (adjusted (a)OR=0.73; 95%CI 0.57, 0.93), with no such association for other SMI or LD. The risk of EP was particularly high in patients with LD (27.3% versus 18% in those without such conditions; aOR=1.84; 95%CI 1.33, 2.54), with schizophrenia (31.9% vs 18%; aOR=1.67; 95%CI 1.34, 2.07), or other psychoses (28.9% vs 18%; aOR=1.37; 95%CI 1.09, 1.73). Overall, having diagnostic investigations 1-6 months pre-cancer was associated with lower odds of EP, independently of SMI or LD, symptoms and other characteristics.
CONCLUSIONS:
Having any of the SMI conditions or LD increased the likelihood of cancer diagnosis following EP. Facilitating access to diagnostic investigations pre-cancer diagnosis for symptomatic individuals may help reduce EP, with patients with schizophrenia appearing to be particularly disadvantaged in accessing investigations.
Patients with severe mental illness (SMI) or learning disabilities (LD) often experience barriers in accessing timely cancer diagnosis, but population-based evidence is scant. We investigated variations in the likelihood of pre-diagnostic investigations for cancer and the risk of cancer diagnosis following emergency presentation (EP) by SMI or LD status.
METHODS:
We used linked CPRD Gold primary care, secondary care and cancer registration data of patients diagnosed with lung, colon, rectum, upper gastrointestinal, pancreatic and hepatobiliary, breast or prostate cancers in England in 2010-2018. We identified patients with SMI (bipolar disorder, schizophrenia or other psychoses) or with learning disability from CPRD records. Using multivariable logistic regression, we explored associations between SMI conditions or LD and i) diagnostic investigations 31-182 days (1-6 months) pre-cancer diagnosis and ii) cancer diagnosis following EP, adjusting for socio-demographic, clinical and healthcare factors.
RESULTS:
Among the 93,363 cancer patients, 1.6% had a record of pre-existing SMI, while 0.3% had a record of LD. Around 16% of patients underwent diagnostic investigations 1-6 months pre-diagnosis. Schizophrenia was associated with reduced odds of investigations 1-6 months pre-diagnosis (adjusted (a)OR=0.73; 95%CI 0.57, 0.93), with no such association for other SMI or LD. The risk of EP was particularly high in patients with LD (27.3% versus 18% in those without such conditions; aOR=1.84; 95%CI 1.33, 2.54), with schizophrenia (31.9% vs 18%; aOR=1.67; 95%CI 1.34, 2.07), or other psychoses (28.9% vs 18%; aOR=1.37; 95%CI 1.09, 1.73). Overall, having diagnostic investigations 1-6 months pre-cancer was associated with lower odds of EP, independently of SMI or LD, symptoms and other characteristics.
CONCLUSIONS:
Having any of the SMI conditions or LD increased the likelihood of cancer diagnosis following EP. Facilitating access to diagnostic investigations pre-cancer diagnosis for symptomatic individuals may help reduce EP, with patients with schizophrenia appearing to be particularly disadvantaged in accessing investigations.
| eISSN: | 2654-1459 |
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