Disparity of end-of-life care in cancer patients with and without schizophrenia: A nationwide population-based cohort study

Background: Cancer patients with schizophrenia may face disparities in end-of life care, and it is unclear whether schizophrenia affects their medical care and treatment. Methods: We conducted a nationwide population-based cohort study based on the National Health Insurance Research Database of Taiwan. The study population included patients > 20 years old who were newly diagnosed as having one of six common cancers between 2000 and 2012 (schizophrenia cohort: 1911 patients with both cancer and schizophrenia; non-schizophrenia cohort: 7644 cancer patients without schizophrenia). We used a multiple logistic regression model to analyze the differences in medical treatment between the two cohorts in the final 1 and 3 months of life. Results: In the 1 month before death, there was higher intensive care unit utilization in the schizophrenia group [odd ratio (OR) = 1.21, 95% confidence interval (CI) = 1.07–1.36] and no significant differences between the groups in-hospital stay length or hospice care. The schizophrenia patients received less chemotherapy (OR = 0.60, 95% CI = 0.55–0.66) but more invasive interventions, such as cardiopulmonary resuscitation (OR = 1.34, 95% CI = 1.15–1.57). Advanced diagnostic examinations, such as computed tomography/magnetic resonance imaging/sonography (OR = 0.80, 95% CI = 0.71–0.89), were used less often for the schizophrenia patients. The 1- and 3-month prior to death results were similar. Conclusion: End-of-life cancer patients with schizophrenia underwent more frequent invasive treatments but less chemotherapy and examinations. Treatment plans/advance directives should be discussed with patients/families early to enhance end-of-life care quality and reduce health care disparities caused by schizophrenia.