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Meta-Analysis
. 2025 Mar 5:64:358-373.
doi: 10.2340/1651-226X.2025.42260.

Colorectal cancer mortality in persons with severe mental illness: a scoping review with meta-analyses of observational studies

Paula R Pop  1 , Gitte S Larsen  1 , Mette K Thomsen  2 , Christoffer Johansen  1 , Robert Zachariae  3 , Bolette Skjødt Rafn  4
Affiliations
Meta-Analysis

Colorectal cancer mortality in persons with severe mental illness: a scoping review with meta-analyses of observational studies

Paula R Pop et al. Acta Oncol. .

Abstract

Background and purpose: Persons with severe mental illnesses (SMIs) have reduced participation in colorectal cancer (CRC) screening programs, higher odds of advanced stage at diagnosis, and are less likely to receive adequate treatment than the general population. It remains unclear to what extent these factors impact CRC outcomes for persons with SMI. The aim of this scoping review was to describe and quantify CRC mortality for persons with SMI compared with the general population.

Patients/materials and methods: We followed the JBI Manual for Evidence Synthesis and PRISMA guidelines in a systematic search of four databases from inception until April 29th, 2024. We included studies that provided CRC mortality estimates for adults with preexisting clinical diagnosis of SMI. We synthesized the results descriptively and pooled the data to estimate the magnitude of the associations.

Results: Twenty-four original studies were identified with a total of 16.4 million persons. Most studies reported increased CRC mortality for persons with SMI compared with persons without SMI. The meta-analysis demonstrated a 25% increased CRC mortality for persons with SMI (e.g. pooled hazard ratio 1.25; 95% confidence interval 1.13 to 1.39; n = 13,178,161).

Interpretation: The evidence points consistently to an increased CRC mortality for persons with SMI compared with persons without SMI. Furthermore, this evidence supports the idea that persons with SMI are a heterogenous population, and as such, any future initiatives to improve CRC outcomes for persons with SMI would warrant a tailored approach to potentiate individual resources, to mitigate stigma and structural discrimination.

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Conflict of interest statement

European Cancer Rehabilitation & Survivorship Symposium (ECRS) 2024 was financially supported by the Acta Oncologica Foundation.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Colorectal cancer mortality hazard ratio, pooled analysis. Only fully adjusted HR-estimates were included in this analysis. Complete information about model adjustment is available in Table 2. Risk estimate.
Figure 3
Figure 3
Colorectal cancer mortality risk ratio in SMI group compared with the control group, pooled analysis. Mortality risk ratio was assessed using the reported sample sizes and events (CRC deaths) for both the SMI group and the control group.
Figure 4
Figure 4
Standardized mortality ratio, pooled analysis. The standardized mortality ratio (SMR) is the ratio between the number of deaths observed in the SMI group and the number of expected deaths estimated from the reference population. SMR = 1 indicates that the number of observed deaths is equal to the number of expected deaths. SMR < 1 indicates fewer observed deaths than expected deaths. SMR > 1 indicates more observed deaths than expected deaths, and the difference between observed deaths and expected deaths is also termed excess deaths.
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References

    1. WHO . Colorectal cancer [Internet]. 2023. [cited 2024 May 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer
    1. Mayer RJ. Lower gastrointestinal cancers. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s principles of internal medicine, 20e [Internet]. New York, NY: McGraw-Hill Education; 2018. [cited 2024 Jun 18]. Available from: accessmedicine.mhmedical.com/content.aspx?aid=1172373125
    1. Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. . Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1260–344. 10.1016/S0140-6736(17)32130-X - DOI - PMC - PubMed
    1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. . Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. 10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. International Agency for Research on Cancer . Cancer Screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening [Internet]. Lyon, France: International Agency for Research on Cancer; 2017. pp. 1–333. Available from: https://health.ec.europa.eu/system/files/2017-05/2017_cancerscreening_2n... [Cited 2024 May 26]

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