Cancer and severe mental illness: Bi‐directional problems and potential solutions

Abstract

Objective: Given the reported increased rates of physical morbidity and higher mortality rates among people with severe mental illness (SMI) (schizophrenia and severe mood disorders), with a life expectancy shorter of 15-20 years with respect to the general population, the aim of this paper was to call attention to the problem of cancer in SMI. Methods: We conducted a narrative review of the most significant papers published in the areas of cancer screening, incidence, mortality and palliative care in SMI. Results: Data from the literature confirm disparities in screening (eg, mammography; pap-smear test; colorectal cancer screening) and prevention (eg, clinical breast examination; smoking cessation). The incidence of cancer was found to be variable with a portion of the studies reporting a higher prevalence while others a similar or a lower prevalence of cancer compared to the general population. A lower percentage of patients with SMI received proper cancer treatment resulting in survival after cancer diagnosis significantly worse than people without SMI. Likewise, end-of-life care has been shown to be lacking with poorer levels of physical, psychological and spiritual care. Conclusions: The problems of stigma and discrimination, poorer dignity, poorer health behavior, lack of integration in health-care services for people with SMI needs to be addressed and solved in cancer care. Psycho-oncology has a very specific and mandatory role in integrating the recommendation of the World Health Organization to improve the links between oncology and mental health settings for more specific psycho-oncology programs addressed for this vulnerable segment of the population.

Cancer care for people with mental disorders: A qualitative survey among cancer care and psychiatric care professionals in Japan

“…Consistent with previous reviews, 19,20,22,23 several issues related to stigma around mental disorders were identified in the present study.…”

“…People with mental disorders often experience problems such as lack of exercise, 26,27 poor eating habits, 26,28 obesity, 28,29 high rates of smoking or substance abuse, 26,[30][31][32][33][34] and low cancer-screening rates. [9][10][11][12] Consistent with previous papers, [19][20][21][22][23] the present study showed that these patients need support in the prevention and early detection of cancer.…”

Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

“…functional impairments (e.g., affective, cognitive, perceptive), health care provider prejudice or fear of violent behavior or suicide, and disintegration of psychiatric and somatic medicine may contribute to this deficit. 23 This situation is unfortunate because psychological interventions have been evidenced to reduce distress significantly. 15,24 Moreover, psychological interventions usually increase treatment adherence 25 and satisfaction, 26,27 may be a mediator in the course and prognosis of cancer, 2,[28][29][30] reduce the length of hospitalizations, 31 reduce financial and emotional burden of health care providers 29 and maximize quality of life in general.…”

“…Most likely, this is due to conservative documentation of mental disorders, which often occurs only when diagnoses are reported by referring/ consulting physicians or when patients disclose they have a mental disorder and allow inspection of treatment records. Mental disorders are often not discussed because patients and treatment teams fear stigmatization23 or because the focus is on physical symptoms.Second, there are many medical reasons for the prescription of psychopharmacology to patients with cancer, including the management of pain (antidepressants), vomiting (antipsychotics), or epileptic seizures (mood stabilizers). It would seem reasonable to exclude the administration of psychopharmacology for non-psychiatric reasons from the present analysis.…”

Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy

“…Available data suggest an increased prevalence of physical illness which results in a life expectancy 15-20 years shorter among individuals with SMI than the general population. [1][2][3][4][5][6][7][8] Cancer has been indicated as one of the main culprits, not only because of its negative impact on quality of life and functioning, but also for the heavy toll it exerts on survival. 9 Preliminary investigations on cancer-related mortality were carried out in the 1980s.…”