Patients With Cancer and Psychosis Receive Less Specialized Palliative Care

Patients with metastatic cancer and a diagnosis of psychosis are less likely to receive specialized palliative care, compared with patients with cancer only. These study findings were reported in the journal Acta Psychiatrica Scandinavica.

The study was a retrospective, observational analysis of registry data involving information on health care consumption obtained from the Stockholm Regional Council in Sweden. The researchers conducting the analysis evaluated utilization and outcomes associated with specialized palliative care in patients older than 18 years who died between 2015 and 2021 and had a diagnosis of metastatic cancer, hematologic malignancy, or malignant brain tumor. Results were analyzed with respect to whether patients also had a psychosis diagnosis. 

Of 23,056 patients with cancer included in the study, 320 also had a diagnosis of psychosis. Patients with cancer and psychosis received specialized palliative care at a significantly lower rate, compared with patients with cancer only (61% vs 74%; P <.0001).

Compared with patients with cancer only, those with cancer and psychosis were younger at death (mean age 73.1 vs 68.5; P <.0001), were more likely to live a nursing home (11% vs 25%; P <.0001), and low area-based socioeconomic status was more prevalent (32% vs 46%; P <.0001), respectively. 

However, among the patients with cancer and psychosis, the probability of emergency department (ED) visits in the last month of life was lower for those who received specialized palliative care than for those who did not (adjusted odds ratio [aOR], 0.57; 95% CI, 0.34-0.97; P =.04). Additionally, residing in a nursing home was also linked to a lower rate of ED visits in patients with cancer and psychosis (aOR, 0.38; 95% CI, 0.20-0.70; P =.002). 

For patients with cancer and psychosis, the likelihood of death at a hospital was lower for those who received specialized palliative care (aOR, 0.8; 95% CI, 0.04-0.17; P <.0001) or resided in a nursing home (aOR, 0.14; 95% CI, 0.12-0.16; P <.0001). However, frailty associated with more hospital deaths.

For patients with cancer only, the likelihood of death at a hospital was lower for those who received specialized palliative care (OR, 0.04; 95% CI, 0.04-0.05; P <.0001), resided in a nursing home (aOR, 0.14; 95% CI, 0.12-0.16; P <.0001), were 75 years and older (aOR, 0.58; 95% CI; 0.52-0.65; P <.0001), or had dementia (aOR, 0.60; 95% CI, 0.48-0.75; P <.0001).

“[T]he findings strongly suggest that a concomitant diagnosis of psychosis acts as a stigma, significantly reducing the probability of receiving specialized palliative care,” the researchers concluded.