1
|
Murphy JF, Amin LB, Celikkaleli ST, Brown HE, Tapan U. Disparities in cancer care in individuals with severe mental illness: A narrative review. Cancer Epidemiol 2024; 93:102663. [PMID: 39255550 DOI: 10.1016/j.canep.2024.102663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/05/2024] [Accepted: 09/04/2024] [Indexed: 09/12/2024]
Abstract
Individuals with severe mental illness (SMI) have higher mortality rates from cancer than individuals without SMI. The aim of this paper is to highlight these disparities in cancer care in individuals with SMI and suggest potential solutions. We conducted a narrative review of published papers, focusing on mortality, incidence, behavioral and provider risk factors, screening, diagnosis, treatment, and palliative care among individuals with SMI and cancer. The literature does not provide a clear consensus on whether a difference in cancer incidence exists among individuals with SMI compared to the general population. However, it is evident that individuals with SMI have higher mortality from cancer. Factors such as increased cancer related risk behavior, mental health stigma, and difficulty accessing cancer care contribute to this mortality difference. The literature also indicates lower screening rates, delayed and improper diagnosis and treatment, as well as inadequate clinical trial enrollment in individuals with SMI. While the literature is inconclusive regarding disparities in palliative care, we outline key concepts to provide the best possible end of life care to this population. We also summarize strategies to address disparities at the screening, diagnostic, and treatment levels and describe general strategic approaches to improve cancer care in individuals with SMI. We highlight patient-related, physician-related, and healthcare/systems-related factors leading to disparities in cancer care in individuals with SMI. Future research must examine the effectiveness of proposed solutions to guide evidence-based practices.
Collapse
Affiliation(s)
- John F Murphy
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, and Boston Medical Center, Boston, MA 02118, USA.
| | - Laura B Amin
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, and Boston Medical Center, Boston, MA 02118, USA
| | - Suheda T Celikkaleli
- Department of Psychiatry, Faculty of Medicine, Yuzuncu Yil University, Van 65090, Turkey
| | - Hannah E Brown
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, and Boston Medical Center, Boston, MA 02118, USA
| | - Umit Tapan
- Section of Hematology & Medical Oncology, Boston University Chobanian & Avedisian School of Medicine, and Boston Medical Center, Boston, MA 02118, USA
| |
Collapse
|
2
|
Glasdam S, Hybholt L, Stjernswärd S. Experiences of Everyday Life among Individuals with Co-Existence of Serious Mental Illness and Cancer-A Qualitative Systematic Literature Review. Healthcare (Basel) 2023; 11:1897. [PMID: 37444731 DOI: 10.3390/healthcare11131897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Daily life with severe mental health (SMI) and cancer comorbidity entails multiple challenges. The study aims to explore everyday life experiences among individuals with SMI and cancer comorbidity from the perspectives of patients, significant others, and involved healthcare professionals. The study is registered in PROSPERO (CRD42021259604). A qualitative systematic review was conducted through searches in the databases MEDLINE, CINAHL, PsychInfo, and Web of Sciences (last search 14 February 2023). Inclusion criteria were empirical qualitative research studies investigating experiences of healthcare and everyday life among persons living with SMI and who were subsequently diagnosed with cancer from the perspective of the individuals themselves, their significant others, and healthcare professionals involved in their care. Exclusion criteria: Literature reviews, quantitative studies, intervention studies, quantitative parts of mix-methods studies, non-English languages, persons <18 years, dementia/learning disabilities, diagnosed with anxiety/depression as a consequence of cancer. Seven articles, published between January 2011 and February 2023, were included and analysed through a thematic analysis. The PRISMA 2020 checklist guided the study. The results were presented in four themes: 'Navigating between different worlds and logics', 'Decision-making capacity depending on the assessor', 'Cancer must give way to severe mental illness or vice versa', and 'Significant others as a safety net'. Research about the everyday lives of persons with SMI and cancer comorbidities from patients' and relatives' perspectives is lacking and thus called for.
Collapse
Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, 222 41 Lund, Sweden
| | - Lisbeth Hybholt
- Research Unit, Mental Health Services East, Psychiatry Region Zealand, Smedegade 16, 4000 Roskilde, Denmark
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark
| | - Sigrid Stjernswärd
- Department of Health Sciences, Faculty of Medicine, Lund University, 222 41 Lund, Sweden
| |
Collapse
|
3
|
Nejat N, Rahbarian A, Shykhan R, Ebrahimpour S, Moslemi A, Khosravani M. Assessment of spiritual needs in cancer patients: A cross-sectional study. J Family Med Prim Care 2023; 12:894-901. [PMID: 37448916 PMCID: PMC10336942 DOI: 10.4103/jfmpc.jfmpc_989_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 08/27/2022] [Indexed: 07/18/2023] Open
Abstract
Introduction Addressing the spiritual needs of patients is an essential component of holistic care in nursing. Acknowledging the spiritual needs of cancer patients enhances the performance of clinical caregivers in providing quality services to such patients. Therefore, caregivers successfully fulfill or decrease the patients' needs and thus increase their adaptation to crises. Methods The present cross-sectional study was conducted to determine the spiritual needs of cancer patients. In this study, 96 cancer patients were selected from Ayatollah Khansari Hospital in Arak, Iran. The required data were collected through a demographic information form and the Persian version of the Spiritual Needs Questionnaire. Ethical Considerations Participants' verbal consent to participate in the study was obtained, and they were assured of anonymity and confidentiality. Results In the present study, the mean age of the participants was 47.82 ± 14.34 years. The frequency distribution of respondents by gender was 36 males (37.5%) and 60 females (62.5%). The mean scores of spiritual needs in the domains of religious needs, need for inner peace, existential needs, and need for giving/generativity were 12.03 ± 3.18, 7.26 ± 3.26, 4.61 ± 2.96, and 4.06 ± 2.32, respectively. The highest and lowest mean values were associated with religious needs and need for giving/generativity, respectively. Religious needs showed a significantly positive relationship with gender, occupation, and the type of treatment (P < 0.05). Moreover, a significant relationship was observed between the need for peace and level of education (P < 0.05). Conclusion The recognition of the spiritual needs of cancer patients is the first step in prioritizing and planning to provide spiritual care to these patients and supporting them in adapting to and coping with the disease. Therefore, nurses need to acquire the fundamental knowledge and skills required to identify these needs.
Collapse
Affiliation(s)
- Nazi Nejat
- PhD in Nursing, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Amir Rahbarian
- MSc of Medical-Surgical Nursing, Students of Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhane Shykhan
- PhD in Psychology, Department of Psychology, Faculty of Humanities, Arak Islamic Azad University, Arak, Iran
| | - Sobhan Ebrahimpour
- Master of Nursing Student, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Azam Moslemi
- PhD of Biostatistics, Department of Biostatistic, Faculty of Medical Sciences, Arak University of Medical Sciences, Arak, Iran
| | - Mahboobeh Khosravani
- MSc of Medical-Surgical Nursing, MSc of Social Sciences, Department of Surgical Technology, School of Allied Medical Sciences, Arak University of Medical, Arak, Iran
| |
Collapse
|
4
|
Khosravani M, Nejat N. Spiritual Experiences of Patients in the Cancer Trajectory: A Content Analysis. Ethiop J Health Sci 2022; 32:1147-1156. [PMID: 36475257 PMCID: PMC9692164 DOI: 10.4314/ejhs.v32i6.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/31/2022] [Indexed: 12/13/2022] Open
Abstract
Background Introduction: Patients with cancer as a life-threatening illness have needs in various dimensions. One of the most crucial dimension is spiritually. The present study was conducted to elucidate the spiritual needs of patients with cancer. Methods A qualitative approach involving face to face semi-structured interviews conducted in Arak city, Iran. In total, 24 participants were recruited through purposive sampling. All interviews were recorded and transcribed verbatim. The data were analyzed using content analysis. Results Patients' experiences of spirituality were classified into four themes, including spiritual needs (need to be in nature, need to communicate with others, need to perform religious practices, need for solitude and reflections, need to trust and security), strategies to address spiritual needs (physical activity, achieving inner peace, communication with the nurse or physician, doing dhikr (Zikr) and pray, reading the religious book and texts, making vows, paying attention to and loving others), reasons for not using spiritual resources (lack of belief in the healing powers of praying, believing in a better life after death), and impacts of spiritual beliefs (hope of Life, belief in divine destiny, trusting in God's support, accepting the divine test). Conclusion Exploring the experiences, perceptions, and spiritual needs of cancer patients is of great importance in providing spiritual care as one of the critical aspects of holistic care. Nurses should be educated for assessing spiritual needs of patients to provide spiritual care.
Collapse
Affiliation(s)
- Mahboobeh Khosravani
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Nazi Nejat
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| |
Collapse
|
5
|
Wootten JC, Richard L, Blanchette PS, Wiener JC, Anderson KK. Cancer incidence and stage at diagnosis among people with recent-onset psychotic disorders: A retrospective cohort study using health administrative data from Ontario, Canada. Psychooncology 2022; 31:1510-1518. [PMID: 35726378 DOI: 10.1002/pon.5983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/13/2022] [Accepted: 06/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Prior evidence on the relative risk of cancer among people with psychotic disorders is equivocal. The objective of this study was to compare incidence and stage at diagnosis of cancer for people with psychotic disorders relative to the general population. METHOD We constructed a retrospective cohort of people with a first diagnosis of non-affective psychotic disorder and a comparison group from the general population using linked health administrative databases in Ontario, Canada. The cohort was followed for incident diagnoses of cancer over a 25-year period. We used Poisson and logistic regression models to compare cancer incidence and stage at diagnosis between people with psychotic disorders and the comparison group, adjusting for confounding factors. RESULTS People with psychotic disorders had an 8.6% higher incidence (IRR=1.09, 95%CI=1.05,1.12) of cancer overall relative to the comparison group, with effect modification by sex and substantial variation across cancer sites. People with psychotic disorders also had 23% greater odds (OR=1.23, 95%CI=1.13,1.34) of being diagnosed with more advanced stage cancer relative to the comparison group. CONCLUSIONS We found evidence of elevated cancer incidence in people with non-affective psychotic disorders relative to the general population. The higher odds of more advanced stage cancer diagnoses in people with psychotic disorders represents an opportunity to improve patient participation in recommended cancer screening, as well as timely access to services for cancer diagnosis and treatment. Future research should examine confounding effects of lifestyle factors and antipsychotic medications on the risk of developing cancer among people with psychotic disorders. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jared C Wootten
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Phillip S Blanchette
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- ICES Western, London, Ontario, Canada
- Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- ICES Western, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
6
|
Gynecological Health Concerns in Women with Schizophrenia and Related Disorders: A Narrative Review of Recent Studies. WOMEN 2022. [DOI: 10.3390/women2010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sex and age are important factors influencing physical and mental health in schizophrenia. Our goal was to review the recent literature for associations between gynecological conditions and psychotic illness and to propose integrated strategies for their management in order to improve overall health outcomes in women. We addressed the following questions: What are the prevalence and risk factors of gynecological disorders in women with schizophrenia or delusional disorder (DD)? What are the rates of uptake of gynecological cancer screening and mortality in this population? What role does menopause play? We found an increased incidence of breast cancer in women with schizophrenia. Other gynecological comorbidities were less frequent, but the field has been understudied. Low rates of breast and cervical cancer screening characterize women with schizophrenia. Menopause, because of endocrine changes, aging effects, and resultant comorbidity is associated with high rates of aggressive breast cancer in this population. Uterine and ovarian cancers have been less investigated. Psychosocial determinants of health play an important role in cancer survival. The findings lead to the recommendation that primary care, psychiatry, gynecology, oncology, and endocrinology collaborate in early case finding, in research into etiological links, and in improvement of prevention and treatment.
Collapse
|
7
|
Grassi L, Riba MB. Disparities and inequalities in cancer care and outcomes in patients with severe mental illness: Call to action. Psychooncology 2021; 30:1997-2001. [PMID: 34874094 DOI: 10.1002/pon.5853] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES People with severe mental illness (SMI) are at extreme risk of being stigmatized and to receive poor quality physical care. It has been demonstrated that they have higher morbidity and poorer prognosis of several medical diseases than the general population, with an at least 10-20-year reduction in life expectancy. METHODS A special issue of Psycho-Oncology focusing on cancer care among patients affected by SMI was called by the Editorial Board of the journal, with the aim to explore cancer health disparities and inequalities among people with SMI, mortality from cancer, problems of communication between multidisciplinary oncology and psychiatric teams and need for more structured intervention (i.e., screening, prevention, treatment). RESULTS Authors from eight countries contributed. The problem of stigma and barriers to cancer care provision for patients with SMI were studied (e.g., the complex nature of SMI and healthcare providers' misunderstanding of SMI). Key barriers were related to both patients, clinicians and institutional problems, such as fragmentation of care. A higher mortality from cancer and poor knowledge about cancer risk-factors was shown in patients with SMI. Models of intervention were also proposed. CONCLUSIONS Several conclusions have been recommended by the authors, such as the need for guidelines and clinical procedures specific for cancer care in mental health settings; large-scale studies to address the disparities of care in people with SMI; a larger vision of psychosocial oncology as the facilitator of the liaison between oncology and psychiatry.
Collapse
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatric Unit, S. Anna Hospital, Ferrara, Italy.,Local Health Trust, Ferrara, Italy
| | - Michelle B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Psychoncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| |
Collapse
|