Problems in management of breast cancer with serious mental illness

Abstract

Purpose: Mental illness patients have difficulty of decision-making for treatment due to their own intellectual and socio-economic problems. Thus, doctors have a large role in course of treatment. In this study, we reviewed characters of breast cancer patients with mental illness and tried to define doctors’ role in course of treatment on the basis of our experience. Methods: We analyzed 12 patients with serious mental illness who had a difficulty on self-decision making who were treated for breast cancer between 2001 and 2012. We retrospectively reviewed medical records and relation with guardians. Results: The median age was 52 years old. Five patients were overweight with body mass index over 25 kg/m2. Seven patients had never been married and 11 patients were nullipara. Modified radical mastectomy was performed in all patients except one who received neoadjuvant chemotherapy. Nine patients were recommended chemotherapy, but only 5 patients were treated with chemotherapy and others were hormone therapy only. Four patients received chemotherapy staying with their family. A single patient was treated with chemotherapy stayed nursing home, but accompanying some intimate guardians while staying at hospital. There were two cases of recurrence, and the rest were being closely monitored without recurrence. Conclusion: More detailed and systematic diagnostic and treatment guideline were required which were not depending on each doctor’s and guardian’s unpredictable opinion in treatment of patients with severe mental illness.

Keywords

• breast cancer
• mental illness
• modified radical mastectomy
• chemotherapy