Maitra, Nanaki;
(2025)
Evaluating The Use of Electronic Healthcare Data Linkages To Investigate The Association Between Severe Mental Illness and Cancer Presentation Characteristics.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Individuals with severe mental illness (SMI) face substantial disparities in cancer presentation characteristics. This thesis defines SMI as schizophrenia spectrum disorders, bipolar disorder, schizoaffective disorder, and major depressive disorder. A key research gap addressed is the limited understanding of how SMI is associated with cancer stage, grade, and diagnostic routes, utilising UK-based electronic healthcare records. Chapter 2 presents a systematic review and meta-analysis of 30 studies assessing the association between pre-existing SMI, cancer stage at diagnosis, and cancer-specific mortality. Findings indicate no conclusive association between SMI and advanced cancer stage at diagnosis (OR 1.12, CI 95% 0.87–1.45), but an association with increased cancer-specific mortality (HR 1.32, CI 95% 1.24–1.40) was identified, particularly for schizophrenia (HR 1.50, CI 95% 1.25–1.81). Chapter 4 evaluates the novel South London and Maudsley NHS Foundation Trust and National Cancer Registration and Analysis Service (SLaM-NCRAS) data linkage, comprising 35,237 cancer cases, including 292 individuals with SMI from 2007–2017. High levels of missing data were observed in key variables, potentially limiting the robustness of subsequent analyses. Chapter 5 leverages the linkage to investigate the association between pre-existing SMI and cancer presentation characteristics, focusing on stage, grade, and cancer diagnostic routes using logistic regression methods. Individuals with SMI are more likely to present with late-stage cancer (OR 2.30, CI 95% 1.63–3.21). Additionally, individuals with schizophrenia are more likely to present with aggressive tumours at diagnosis (OR 2.06, CI 95% 1.24–3.48). Individuals with SMI are also more likely to be diagnosed via emergency pathways compared to those without SMI (OR 2.71, CI 95% 2.10–3.47), particularly pronounced among schizophrenia and other psychotic disorder patients. This PhD thesis highlights the differences in cancer presentation at diagnosis for individuals with SMI, underscoring the need for integrated healthcare approaches to address cancer care disparities.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Evaluating The Use of Electronic Healthcare Data Linkages To Investigate The Association Between Severe Mental Illness and Cancer Presentation Characteristics |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2025. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10211338 |
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