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Pre-existing mental illness and breast cancer among elderly patients in the US

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TitleInfo
Title
Pre-existing mental illness and breast cancer among elderly patients in the US
SubTitle
a SEER-medicare database analysis
Name (type = personal)
NamePart (type = family)
Iglay
NamePart (type = given)
Kristy Ann
NamePart (type = date)
1981-
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Kristy Ann Iglay
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RoleTerm (authority = RULIB)
author
Name (type = personal)
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DEMISSIE
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KITAW
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KITAW DEMISSIE
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Advisory Committee
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chair
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GEORGE
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GEORGE RHOADS
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Advisory Committee
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internal member
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NamePart (type = family)
LIN
NamePart (type = given)
YONG
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YONG LIN
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Advisory Committee
Role
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internal member
Name (type = personal)
NamePart (type = family)
Hirshfield
NamePart (type = given)
Kim M.
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Kim M. Hirshfield
Affiliation
Advisory Committee
Role
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outside member
Name (type = personal)
NamePart (type = family)
Williams
NamePart (type = given)
Jill
DisplayForm
Jill Williams
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
outside member
Name (type = corporate)
NamePart
Rutgers University
Role
RoleTerm (authority = RULIB)
degree grantor
Name (type = corporate)
NamePart
Graduate School - New Brunswick
Role
RoleTerm (authority = RULIB)
school
TypeOfResource
Text
Genre (authority = marcgt)
theses
OriginInfo
DateCreated (qualifier = exact)
2015
DateOther (qualifier = exact); (type = degree)
2015-05
CopyrightDate (encoding = w3cdtf); (qualifier = exact)
2015
Place
PlaceTerm (type = code)
xx
Language
LanguageTerm (authority = ISO639-2b); (type = code)
eng
Abstract (type = abstract)
The effect of pre-existing mental illness on diagnosis/treatment delays and survival in elderly patients with breast cancer is poorly defined in the literature. Because early detection and treatment are critical to long-term survival, it is important to identify the role of pre-existing mental illness in diagnosis and treatment delays of breast cancer. Therefore, this study sought to (1) describe the demographic, clinical, and tumor characteristics of elderly patients with pre-existing mental illness that were also diagnosed with breast cancer; (2) compare diagnosis and treatment delays of elderly breast cancer patients with and without pre-existing mental illness, and (3) compare rates of all cause and breast cancer-specific survival for elderly patients with and without mental illness. A retrospective cohort study of women aged 68+ at breast cancer diagnosis (stage I, II, or IIIa) was conducted using the SEER-Medicare database. Descriptive statistics, logistic regression, binomial regression, Cox proportional Hazards regression and competing risk models were utilized for the analysis. Compared to those without mental illness, those with mental illness were slightly more likely to be white, reside in neighborhoods with a lower income, use tobacco, and have more medical comorbidities. Breast cancer patients with pre-existing mental illness were also less likely to receive mammography and to be married. Compared to those without mental illness, a higher proportion of patients with mental illness had poorly differentiated tumors and more positive lymph nodes. Breast-conserving surgery was more common than mastectomies overall, but patients with mental illness were less likely to receive adjuvant radiation following this procedure compared to those without mental illness. There were no significant differences in the risk of diagnosis, initial treatment, surgery, or adjuvant radiation treatment delays of ≥60 days or ≥90 days for those with versus without mental illness. However, breast cancer patients with pre-existing mental illness experienced a significant 13% higher risk of adjuvant chemotherapy delay of ≥90 days. When examining these associations by type of mental illness, patients with a diagnosis of both anxiety and depression were more likely to experience an increased risk of a diagnosis delay of ≥90 days. Breast cancer patients with major psychiatric illness (i.e., bipolar disorder, schizophrenia, or other psychotic disorders) were more likely to experience a prolonged initial treatment delay of ≥60 days. Patients with mental illness compared to those without faced a significant 43% increase in the rate of all-cause mortality and a non-significant 12% increase in the rate of breast cancer-specific mortality. The increased mortality from all causes remained for each category of mental illness, but the strongest impact was seen in those with major psychiatric illness (127% increased rate of all-cause death). Although the presence of mental illness overall did not significantly impact the rate of breast cancer death, a significant 40% increased rate was observed for patients with major psychiatric illness compared to those without mental illness. The findings of this dissertation provide evidence that breast cancer patients with major psychiatric illness experience significant treatment delays and face shorter survival. Breast cancer patients with major psychiatric illness would benefit from increased coordination of care among psychiatrists, primary care physicians, and other specialties. The reason for the increased breast cancer death rate in patients with pre-existing major psychiatric disorders deserves attention in order to understand the underlying mechanism(s).
Subject (authority = RUETD)
Topic
Public Health
Subject (authority = ETD-LCSH)
Topic
Breast--Cancer
Subject (authority = ETD-LCSH)
Topic
Geriatric oncology--United States
Subject (authority = ETD-LCSH)
Topic
Medicare--Data processing
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
Identifier
ETD_6310
PhysicalDescription
Form (authority = gmd)
electronic resource
InternetMediaType
application/pdf
InternetMediaType
text/xml
Extent
1 online resource (vii, 115 p. : ill.)
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
Note (type = statement of responsibility)
by Kristy Ann Iglay
RelatedItem (type = host)
TitleInfo
Title
Graduate School - New Brunswick Electronic Theses and Dissertations
Identifier (type = local)
rucore19991600001
Location
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NjNbRU
Identifier (type = doi)
doi:10.7282/T3GT5Q1R
Genre (authority = ExL-Esploro)
ETD doctoral
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Rights

RightsDeclaration (ID = rulibRdec0006)
The author owns the copyright to this work.
RightsHolder (type = personal)
Name
FamilyName
Iglay
GivenName
Kristy
MiddleName
Ann
Role
Copyright Holder
RightsEvent
Type
Permission or license
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2015-04-11 15:28:47
AssociatedEntity
Name
Kristy Iglay
Role
Copyright holder
Affiliation
Rutgers University. Graduate School - New Brunswick
AssociatedObject
Type
License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
RightsEvent
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2015-05-31
DateTime (encoding = w3cdtf); (qualifier = exact); (point = end)
2017-05-30
Type
Embargo
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after May 30th, 2017.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
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ETD
OperatingSystem (VERSION = 5.1)
windows xp
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