Health Disparities: Cancer Screening, Prevention, and Treatment in People With Mental Illness
Health care system and societal factors are critical components leading to health disparities, as revealed in a new report that focuses on cancer in people with mental illness. The report was published in CA: A Cancer Journal for Clinicians (doi:10.3322/caac.21334).
In the last year, nearly 1 in 5 adults were reported to suffer any mental illness, and almost 10 million US adults had a serious mental illness such as schizophrenia or bipolar disorder. Despite a high prevalence of mental illness among adults, widespread recognition of the health disparities experienced by this population has occurred only in the last decade.
Lifestyle factors such as smoking or limited adherence to treatment are often cited as significant issues that shape cancer risk among persons with mental illness. However, existing societal factors are also crucial contributors to this increased risk.
In this report, researchers led by Lara C. Weinstein, MD, MPH, of Thomas Jefferson University in Philadelphia, Pennsylvania, reviewed existing literature on cancer prevention, screening, and treatment for people with mental illness.
Although interventions that address tobacco dependence and obesity among these patients are in development, evidence of their effectiveness remains limited. Essentially all preventive interventions focus at the individual level. A focus solely on individual-level measures may be criticized as blaming the victim, which can be particularly problematic for marginalized and stigmatized populations as these interventions often fail to acknowledge environmental and societal barriers to good health.
The researchers offer recommendations to improve cancer prevention screening and treatment in people with mental illness. In addition to measures to manage weight and reduce tobacco use and dependence, clinicians can consider metformin to help people with schizophrenia manage obesity or rapid weight gain and bupropion or varenicline to help psychiatrically stable patients overcome nicotine dependence.
Clinicians are urged to work with community-based social support staff, as they often have long-term relationships with patients, from early in the diagnostic and treatment process. A conscious effort should be made to avoid the tendency to attribute physical symptoms that may indicate cancer to the patient's mental illness. Furthermore, educational programs that increase mental health service providers' awareness of cancer screening may be needed.
"Improving cancer prevention and control efforts in people with mental illness will require fully integrating medical and behavioral health care in settings that commonly provide services to this population, such as community mental health care sites, community service centers, and supportive housing, so that health interventions are brought to people's doorsteps, reducing the access and engagement barriers that are contributing to existing disparities," said the researchers in their report.