癌症是严重精神疾病（SMI）患者死亡的主要原因之一。尽管他们的癌症发病率与普通人群相似，有时甚至可能较低，但他们的癌症死亡率仍然较高。研究越来越多地探讨医疗保健提供和护理公平在死亡率中的作用，但现有研究的范围有限。在这种背景下，我们的目标是在全国范围内比较患有和不患有 SMI 的患者从筛查到临终关怀的结直肠癌 (CRC) 护理途径。这项研究利用了法国国家癌症中心的真实世界数据覆盖整个人群的健康声称数据库，用于评估 2015-2018 年发生 CRC 的患者的癌症筛查、诊断、治疗和治疗后随访以及护理质量 (QOC) 路径，考虑他们是否接受过治疗现有的 SMI。我们将 SMI 患者与三名患者进行匹配，这些患者没有年龄、性别、居住地区、癌症发病年份、癌症类型和就诊地点，也没有国家制定的 CRC 护理质量指标和针对相关社会经济调整的回归模型、临床和护理提供者相关的协变量。在发生 CRC 的患者中，1,532 名先前存在 SMI 的个体与没有 SMI 的个体进行了匹配。调整协变量后，患有 SMI 的结肠癌和直肠癌患者参与国家 CRC 筛查计划和接受高级诊断检查（例如结肠镜检查和多项补充诊断检查）的可能性较小。他们接受联合治疗（例如新辅助化疗、放疗和切除）以及获得靶向治疗或卡培他滨的几率也较低，但接受侵入性护理（例如造口）的几率较高。患有 SMI 的结肠癌患者更有可能根本没有接受治疗，而患有 SMI 的直肠癌患者接受治疗后随访的可能性较小。两组患者均观察到 QOC 不理想，但 SMI 患者的 QOC 程度较高，侧重于诊断和治疗后随访的指标具有统计显着性差异。我们的研究结果揭示了 CRC 患者之间在 CRC 护理连续过程中的差异以及在没有 SMI 的情况下，并提供初步途径，说明未来应集中精力解决这些问题，特别是在癌症护理途径的进入和退出阶段，同时呼吁进一步研究阻碍 SMI 患者获得公平身体保健的机制。

Cancer is one of the main causes of death in persons with severe mental illness (SMI). Although their cancer incidence is similar, or sometimes even potentially lower compared to the general population, their cancer mortality remains higher. The role of healthcare provision and care equity in this mortality is increasingly being addressed in research, but available studies are limited in their scope. In this context, our aim was to compare colorectal cancer (CRC) care pathways from screening to end-of-life care in patients with and without pre-existing SMI on a national scale.This research leverages real-world data from the French national health claims database, covering the entire population, to assess cancer screening, diagnosis, treatment and post-treatment follow-up as well as quality of care (QOC) pathways among patients with incident CRC in 2015-2018, considering whether they had pre-existing SMI. We matched patients with SMI with three patients without - on age, sex, region of residence, year of cancer incidence and cancer type and location at presentation - as well as nationally established quality of CRC care indicators and regression models adjusting for relevant socio-economic, clinical and care provider-related covariates.Among patients with incident CRC, 1,532 individuals with pre-existing SMI were matched with individuals without SMI. After adjusting for covariates, both colon and rectal cancer patients with SMI were less likely to participate in the national CRC screening programme and to receive advanced diagnostic examinations (e.g., colonoscopies and several complementary diagnostic examinations). They also had lower odds of receiving combined treatments (e.g., neoadjuvant chemotherapy, radiotherapy and excision) and of having access to targeted therapy or capecitabine but higher odds for invasive care (e.g., stoma). Colon cancer patients with SMI were also more likely to have no treatment at all, and rectal cancer patients with SMI were less likely to receive post-treatment follow-up. Suboptimal QOC was observed for both groups of patients, but to a higher extent for patients with SMI, with statistically significant differences for indicators focusing on diagnosis and post-treatment follow-up.Our findings reveal discrepancies across the care continuum of CRC between individuals with and without SMI and provide initial avenues on where to focus future efforts to address them, notably at the entry and exit stages of cancer care pathways, while calling for further research on the mechanisms preventing equity of physical healthcare for individuals with SMI.