CHALLENGES TO COMMUNICATON
Oftentimes patients with SMI are stereotyped as being “difficult” or “noncompliant” by health care professionals. This can interfere with the level of care a patient with SMI receives, eg, cancer symptoms may be overlooked as symptoms related to the patient’s SMI, an oncologist’s reluctance to recommend a clinical trial for a patient with SMI because they are perceived as noncompliant.4 Health care professionals may experience frustration and even anger with the SMI cancer patients because of their lack of follow through, self-neglect, and specific behavioral idiosyncrocies related to their SMI diagnosis.3
This may be compounded due to the nature of the SMI, as the patient may already be reluctant to discuss his or her symptomology, depending on the level of SMI symptom control. Although antipsychotic medication alleviates positive symptoms (hallucinations and delusions) of psychotic disorders such as schizophrenia, the negative (flat and blunted affect) and cognitive symptoms may persist. Moreover, the level of control of the SMI may significantly affect the outcome of the patient’s care.3
Improving cancer care for patients with concurrent SMI diagnoses entails an understanding of the SMI diagnosis, and collaboration with other members of the interdisciplinary team, such as psychiatrists, social workers, primary care physicans, and also family members. Family members can provide accurate patient history information that may not otherwise be available to the clinicians for various reasons.
Psychiatrists and social workers have the unique ability to create an alliance with the patient and aid the patient in understanding the cancer diagnosis, the treatment, and monitor their reactions to treatment or other members of the interdisciplinary team. They can also provide psychoeducation about cancer and the prescribed treatment, and case management services. Communication among interdisciplinary team members is key. Oncologists, although they are medical practitioners, may not possess expertise relating to their patient’s SMI; therefore, consultation with the mental health care team can enable the oncologist to focus on the quality of the patient’s cancer care, thereby optimizing outcomes for the patient.4 Earlier consultation with the patient’s mental health team will also provide the oncologist with a better understanding of the patient’s SMI, further enhancing the care provided by the clinician.
Our role as health care professionals, social service providers, and mental health practitioners is not only to assess, diagnose, and provide treatment, but also to provide a safe environment for the patient during a trying time where they feel the most vulnerable. This is certainly true with the SMI population. Having an SMI should not be a barrier to receiving the best and most up-to-date cancer treatment.
Maryrose Mongelli is an oncology social worker with CancerCare.
1. Millman J, Galway K, Santin O, Reid J. Cancer and serious mental illness—patient, caregiver and professions perspectives: study protocol. J Adv Nurs. 2016;72(1):217-226.
2. Mental and substance use disorders. Substance Abuse and Mental Health Services Administration (SAMHSA) Web site. http://www.samhsa.gov/disorders. Last updated March 8, 2016. Accessed June 24, 2016.
3. Cole M, Padmanabhan A. Breast cancer treatment of women with schizophrenia and bipolar disorder from Philadelphia, PA: lessons learned and suggestions for improvement. J Cancer Educ. 2012;27(4):774-779.
4. Irwin KE, Henderson DC, Knight HP, Pirl WF. Cancer care for individuals with schizophrenia. Cancer. 2014;120(3):323-334.