Impact of the National Bowel Cancer Screening Program on colorectal cancer outcomes for people over the age of 50 with severe mental illness
Cancer is one of the major causes of death among people with a psychiatric illness. Our previous research has shown that cancer incidence rates in people with severe mental illness (SMI) are similar to those in the general population, but that cancer mortality is higher in those with SMI than those in the general population. Lifestyle, such as diet or alcohol use, is unlikely to be the explanation. Other reasons could include:
- Poor cancer screening participation rates in those with mental illness;
- delays in diagnosis leading to more advanced disease at diagnosis; and
- sub-optimal post-diagnosis management.
Australia’s National Bowel Cancer Screening Program (NBCSP) provides a unique opportunity to determine where the major barriers to optimal cancer care for those with SMI occur. We propose a data linkage study using Commonwealth data (NBCSP, Medicare, Pharmaceutical Benefits Scheme, Australian Cancer Database & the National Death Index) to compare colo-rectal cancer care pathways in people with SMI to those from the general population. We will link these to the NSW cancer registry and hospital data for information on cancer staging on NSW residents, as this is the only large jurisdiction to hold these data.
People with SMI (i.e. schizophrenia or bipolar affective disorder) will be defined using the Pharmaceutical Benefits Scheme (PBS) streamlined authority system. This provides a specific code for schizophrenia or bipolar affective disorder whenever an atypical antipsychotic is prescribed. We will also include Lithium prescriptions, for which the specific indication is bipolar affective disorder. Barriers to participation will be explored in consultation with people with experience of SMI & colorectal cancer.
We hypothesise that people with SMI will have lower screening rates and be more likely to present with more advanced cancer. They will also be less likely to receive the appropriate specialist surgical procedures, chemotherapy or radiotherapy.
Funded by
NHMRC Project Grant 2018 (2019- 2021)
Lead Investigators
- Professor Steve Kisely, The University of Queensland
- CIB Doctor Susan Jordan, QIMR Berghofer Medical Research Institute
- CIC Associate Professor David Lawrence, University of Western Australia
- CID Associate Professor Grant Sara, University of Sydney
- CIE Doctor Bradley Kendall, The University of Queensland
- CIF Associate Professor Lisa Brophy, University of Melbourne
- CIG Associate Professor Dan Siskind, The University of Queensland
- CIH Doctor Melinda Protani, The University of Queensland
