Cancer is a pandemic. Given new advances in cancer detection, increased screening, and a growing aged population, the next 20 years will see a significant increase in cancer diagnoses, effecting approximately 70% of the world’s population.1 Moreover, cancer does not discriminate, often affecting vulnerable populations. This article addresses the barriers to treatment for cancer patients with concurrent serious and persistent mental illness (SMI).
The Substance Abuse and Mental Health Services Administration defines serious mental illness as a mental, behavioral, or emotional disorder in a person 18 years or older diagnosable over a period of one year that impairs one’s ability to function on a personal level and a societal level, as well as substantially inhibiting major life activities, such as schizophrenia, bipolar disorder, and major depressive disorder.2
IMPACT ON DECISION MAKING
Patients with SMI often experience stigma related to their illness, frequently causing them to isolate themselves from systems they perceive as exclusionary, including but not limited to the medical community. Therefore, cancer often goes undiagnosed in such patients, until later stages or when metastasis occurs. Moreover, once a patient with SMI receives a cancer diagnosis, there are significant barriers to receiving adequate treatment, such as the patient’s understanding of the diagnosis, commitment to treatment, psychotropic drug interactions with specific chemotherapy treatments, and the treating physicians’ frustration.
Serious mental illness diagnoses can affect a person’s cognitive and executive functioning, and as such, the lack of understanding of a cancer diagnosis may act as a barrier to treatment. Patients with SMI are often socially isolated, have poor memory recall, and a lack of education3; these circumstances effect the patient’s ability to understand the depth of a cancer diagnosis and the treatment protocol. These barriers fundamentally affect the SMI patient’s ability to adhere to prescribed cancer treatment (eg, attending chemotherapy appointments, making lifestyle changes as suggested by the treating physician), which may significantly impact the mortality rate within this vulernable population. This is not to say that a person with SMI and a concurrent cancer diagnosis does not have the capacity to make informed medical decisions about their treatment. In fact, with proper psychoeducation and adherence to psychiatric medication protocol, patients with SMI can make informed decisions about their cancer care.3 The SMI patient’s level of functioning prior to the cancer diagnosis should be a good baseline indicator of the patient’s ability to make informed medical decisions.