{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T08:14:26Z","timestamp":1792138466046,"version":"4.4.0"},"reference-count":45,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"unspecified","delay-in-days":135,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol Psychiatr Sci"],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S2045796024000234_sec1a\">\n\t    <jats:title>Aims<\/jats:title>\n\t    <jats:p>Cancer is one of the main causes of death in persons with severe mental illness (SMI). Although their cancer incidence is similar, or sometimes even potentially lower compared to the general population, their cancer mortality remains higher. The role of healthcare provision and care equity in this mortality is increasingly being addressed in research, but available studies are limited in their scope. In this context, our aim was to compare colorectal cancer (CRC) care pathways from screening to end-of-life care in patients with and without pre-existing SMI on a national scale.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2045796024000234_sec2b\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>This research leverages real-world data from the French national health claims database, covering the entire population, to assess cancer screening, diagnosis, treatment and post-treatment follow-up as well as quality of care (QOC) pathways among patients with incident CRC in 2015\u20132018, considering whether they had pre-existing SMI. We matched patients with SMI with three patients without \u2013 on age, sex, region of residence, year of cancer incidence and cancer type and location at presentation \u2013 as well as nationally established quality of CRC care indicators and regression models adjusting for relevant socio-economic, clinical and care provider-related covariates.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2045796024000234_sec3c\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Among patients with incident CRC, 1,532 individuals with pre-existing SMI were matched with individuals without SMI. After adjusting for covariates, both colon and rectal cancer patients with SMI were less likely to participate in the national CRC screening programme and to receive advanced diagnostic examinations (e.g., colonoscopies and several complementary diagnostic examinations). They also had lower odds of receiving combined treatments (e.g., neoadjuvant chemotherapy, radiotherapy and excision) and of having access to targeted therapy or capecitabine but higher odds for invasive care (e.g., stoma). Colon cancer patients with SMI were also more likely to have no treatment at all, and rectal cancer patients with SMI were less likely to receive post-treatment follow-up. Suboptimal QOC was observed for both groups of patients, but to a higher extent for patients with SMI, with statistically significant differences for indicators focusing on diagnosis and post-treatment follow-up.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2045796024000234_sec4d\">\n\t    <jats:title>Conclusions<\/jats:title>\n\t    <jats:p>Our findings reveal discrepancies across the care continuum of CRC between individuals with and without SMI and provide initial avenues on where to focus future efforts to address them, notably at the entry and exit stages of cancer care pathways, while calling for further research on the mechanisms preventing equity of physical healthcare for individuals with SMI.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s2045796024000234","type":"journal-article","created":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T09:23:12Z","timestamp":1715764992000},"source":"Crossref","is-referenced-by-count":12,"title":["The double burden of severe mental illness and cancer: a population-based study on colorectal cancer care pathways from screening to end-of-life care"],"prefix":"10.1017","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5615-0639","authenticated-orcid":false,"given":"A.-V.","family":"Sepp\u00e4nen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Daniel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Houzard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Le Bihan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Coldefy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Gandr\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,5,15]]},"reference":[{"key":"S2045796024000234_ref5","doi-asserted-by":"crossref","first-page":"S104","DOI":"10.1016\/j.jmir.2023.01.007","article-title":"How does severe mental illness impact on cancer outcomes in individuals with severe mental illness and cancer? A scoping review of the literature","volume":"54","author":"Charlesworth","year":"2023","journal-title":"Journal of Medical Imaging and Radiation Sciences"},{"key":"S2045796024000234_ref20","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/S1470-2045(10)70085-1","article-title":"Cancer diagnosis in people with severe mental illness: Practical and ethical issues","volume":"11","author":"Howard","year":"2010","journal-title":"The Lancet Oncology"},{"key":"S2045796024000234_ref1","first-page":"1","article-title":"Local potential accessibility (LPA): A new measure of accessibility to private general practitioners","volume":"174","author":"Barlet","year":"2012","journal-title":"Questions D\u2019\u00e9conomie de La Sant\u00e9"},{"key":"S2045796024000234_ref9","first-page":"1","article-title":"Persons with severe mental disorders: Life expectancy is greatly reduced and premature mortality has quadrupled","volume":"237","author":"Coldefy","year":"2018","journal-title":"Issues in Health Economics"},{"key":"S2045796024000234_ref42","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1192\/bjp.bp.111.092718","article-title":"Physical health disparities and mental illness: The scandal of premature mortality","volume":"199","author":"Thornicroft","year":"2011","journal-title":"The British Journal of Psychiatry"},{"key":"S2045796024000234_ref8","unstructured":"CNAM (2022b). M\u00e9thodologie m\u00e9dicale de la cartographie des pathologies et des d\u00e9penses, version G9 (ann\u00e9es 2015 \u00e0 2020, Tous R\u00e9gimes) . 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Caisse nationale d\u2019assurance maladie."},{"key":"S2045796024000234_ref35","volume-title":"EU Country Cancer Profile: France 2023","year":"2023"},{"key":"S2045796024000234_ref29","unstructured":"Liu, D , Choi, K , Lizano, P , Yuan, W , Yu, K-Y , Smoller, J and Kohane, I (2022) Construction of extra-large scale screening tools for risks of severe mental illnesses using real world healthcare data. 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Am\u00e9liorer la qualit\u00e9 du syst\u00e8me de sant\u00e9 et maitriser les d\u00e9penses: Propositions de l\u2019Assurance maladie pour 2023. 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des professionnels de sant\u00e9 [Online database]. Paris, Direction de la recherche, des \u00e9tudes, de l\u2019\u00e9valuation et des statistiques. https:\/\/drees.shinyapps.io\/demographie-ps\/ (accessed 7 July 2023 )."},{"key":"S2045796024000234_ref15","first-page":"1","article-title":"Barriers, levers, and contrasts in complex care pathways: The case of cancer amongst people living with a severe mental illness","volume":"281","author":"Gandr\u00e9","year":"2023","journal-title":"Issues in Health Economics"},{"key":"S2045796024000234_ref41","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/S2215-0366(23)00179-7","article-title":"Mental disorders, participation, and trajectories in the Danish colorectal cancer screening programme: A population-based cohort study","volume":"10","author":"Thomsen","year":"2023","journal-title":"The Lancet Psychiatry"},{"key":"S2045796024000234_ref17","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare11131897","article-title":"Experiences of everyday life among individuals with co-existence of serious mental illness and cancer\u2014A qualitative systematic literature review","volume":"11","author":"Glasdam","year":"2023","journal-title":"Healthcare"},{"key":"S2045796024000234_ref16","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"9","year":"2022","journal-title":"The Lancet Psychiatry"},{"key":"S2045796024000234_ref31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0235409","article-title":"The effect of a severe psychiatric illness on colorectal cancer treatment and survival: A population-based retrospective cohort study","volume":"15","author":"Mahar","year":"2020","journal-title":"PLoS One"},{"key":"S2045796024000234_ref43","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1177\/0004867418814945","article-title":"Colorectal, cervical and prostate cancer screening in Australians with severe mental illness: Retrospective nation-wide cohort study","volume":"53","author":"Tuesley","year":"2019","journal-title":"Australian and New Zealand Journal of Psychiatry"},{"key":"S2045796024000234_ref25","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1001\/jamapsychiatry.2013.278","article-title":"Cancer-related mortality in people with mental illness","volume":"70","author":"Kisely","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"S2045796024000234_ref30","unstructured":"Loretti, A (2021) La fabrique des in\u00e9galit\u00e9s sociales de sant\u00e9 . Presses de l\u2019Ecole des hautes \u00e9tudes en sant\u00e9 publique."},{"key":"S2045796024000234_ref2","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.14309\/ajg.0000000000001742","article-title":"Effect of chronic comorbidities on follow-up colonoscopy after positive colorectal cancer screening results: A population-based cohort study","volume":"117","author":"Bhatia","year":"2022","journal-title":"The American Journal of Gastroenterology"},{"key":"S2045796024000234_ref4","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780190937300.001.0001","volume-title":"Addressing Health Inequities in People with Serious Mental Illness: A Call to Action","author":"Cabassa","year":"2023"}],"container-title":["Epidemiology and Psychiatric Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2045796024000234","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T09:23:54Z","timestamp":1715765034000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2045796024000234\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024]]},"references-count":45,"alternative-id":["S2045796024000234"],"URL":"https:\/\/doi.org\/10.1017\/s2045796024000234","relation":{},"ISSN":["2045-7960","2045-7979"],"issn-type":[{"value":"2045-7960","type":"print"},{"value":"2045-7979","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024]]},"article-number":"e27"}}