1
|
Grassi L, McFarland D, Riba M. The Risk and The Course of Cancer Among People with Severe Mental Illness. Clin Pract Epidemiol Ment Health 2023; 19:e174501792301032. [PMID: 38659632 PMCID: PMC11037550 DOI: 10.2174/17450179-v17-e211208-2021-ht2-1910-8] [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: 02/27/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 04/26/2024]
Abstract
The paucity of data regarding patients with Serious Mental Illness (SMI) and cancer is alarming given the fact that people with SMI, especially schizophrenia, bipolar disorders and severe depressive disorders, have in general poorer access to physical health care and higher morbidity and mortality because of physical illnesses. The aims of this review were to examine the current evidence from existing literature on the risk of developing cancer and its course among people with SMI. Equivocal results emerge regarding the risk of developing some kind of cancer among people with SMI, with contrasting data on a possible higher, similar or lower risk in comparison with the general population. In contrast, a series of studies have pointed out that patients with SMI who develop cancer are less likely to receive standard levels of cancer care, both in terms of screening, diagnosis and treatment. Also, the mortality for cancer has been confirmed to be higher than the general population. A global sensitization about these problems is mandatory in an era in which community psychiatry has been developed in all countries and that policies of prevention, treatment, follow up, and palliative care should regard all the segments of the population, including people with SMI, through an interdisciplinary approach.
Collapse
Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, DInstitute of Psychiatry, University of Ferrara and University Hospital Psychiatric Unit, Ferrara, Italy
| | - Daniel McFarland
- Department of Medicine, Hofstra University, Northwell Health, Lenox Hill Hospital, New York, NY, US
| | - Michelle Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Psycho-oncology Program, University of Michigan Depression Center and Rogel Cancer Center, Ann Arbor, MI, USA
| |
Collapse
|
2
|
Steffens EB, Park ER, Muzikansky A, Streck JM, Ostroff JS, Rasmussen AW, Ponzani C, Perez GK, Regan S, Rigotti NA, Irwin KE. Patients With Serious Mental Illness Can Engage in Tobacco Treatment Trials and Tobacco Cessation Interventions During Cancer Treatment. JCO Oncol Pract 2023; 19:e238-e247. [PMID: 36351206 PMCID: PMC9970276 DOI: 10.1200/op.22.00505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE More than half of individuals with serious mental illness (SMI) smoke, contributing to premature cancer mortality. A cancer diagnosis provides an opportunity to assist with smoking cessation; however, supportive oncology trials frequently exclude patients with SMI. To fill this gap, we examined differences in engagement and tobacco cessation in a pragmatic clinical trial. METHODS We recruited 303 participants from two National Cancer Institute-designated Comprehensive Cancer Centers, of which 10% had prior diagnoses of SMI (major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders). We compared self-reported smoking behaviors, patient attitudes and beliefs about cessation, and rates of trial completion, engagement, and smoking abstinence among recently diagnosed patients with cancer with and without SMI. Six months after trial completion, we completed qualitative interviews on barriers and facilitators to tobacco cessation in a random sample of participants with SMI. RESULTS Trial participants with SMI had similar motivation to quit smoking as those without SMI. Additionally, participants with SMI had a similar ability to engage in a tobacco treatment trial (6.5 counseling sessions completed v 7.3 sessions) and benefit from tobacco treatment as those without SMI (32.3% v 27.8% 6-month quit rates). CONCLUSION Patients with cancer and SMI were able to engage in and benefit from a tobacco cessation trial integrated into cancer care. A cancer diagnosis provides an opportunity to assist patients with SMI with smoking cessation referrals and treatment. Pragmatic supportive oncology trials that include a diverse population of adults with SMI are needed to inform care delivery and improve cancer outcomes for patients with SMI and cancer.
Collapse
Affiliation(s)
- Eleanor B. Steffens
- Department of Psychological Sciences, University of Missouri—St Louis, St Louis, MO
| | - Elyse R. Park
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Massachusetts General Hospital Cancer Center, Center for Psychiatric Oncology and Behavioral Sciences, Boston, MA
| | - Alona Muzikansky
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Joanna M. Streck
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Autumn W. Rasmussen
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
| | - Colin Ponzani
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
| | - Giselle K. Perez
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Susan Regan
- Harvard Medical School, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Nancy A. Rigotti
- Harvard Medical School, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kelly E. Irwin
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Massachusetts General Hospital Cancer Center, Center for Psychiatric Oncology and Behavioral Sciences, Boston, MA
- Massachusetts General Hospital Schizophrenia Program, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
3
|
Irwin KE, Callaway CA, Corveleyn AE, Pappano CR, Barry MJ, Tiersma KM, Nelson ZE, Fields LE, Pirl WF, Greer JA, Temel JS, Ryan DP, Nierenberg AA, Park ER. Study protocol for a randomized trial of bridge: Person-centered collaborative care for serious mental illness and cancer. Contemp Clin Trials 2022; 123:106975. [PMID: 36307008 PMCID: PMC11033617 DOI: 10.1016/j.cct.2022.106975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Individuals with serious mental illness (SMI) experience inequities in cancer care that contribute to increased cancer mortality. Involving mental health at the time of cancer diagnosis may improve cancer care delivery for patients with SMI yet access to care remains challenging. Collaborative care is a promising approach to integrate mental health and cancer care that has not yet been studied in this marginalized population. METHODS/DESIGN We describe a 24-week, two-arm, single-site randomized trial of person-centered collaborative care (Bridge) for patients with SMI (schizophrenia, bipolar disorder, or major depression with psychiatric hospitalization) and their caregivers. 120 patients are randomized 1:1 to Bridge or Enhanced Usual Care (EUC) along with their caregivers. Researchers proactively identify individuals with SMI and a new breast, lung, gastrointestinal, or head and neck cancer that can be treated with curative intent. EUC includes informing oncologists about the patient's psychiatric diagnosis, notifying patients about available psychosocial services, and tracking patient and caregiver outcomes. Bridge includes a proactive assessment by psychiatry and social work, a person-centered, team approach including collaboration between mental health and oncology, and increased access to evidence-based psycho-oncology care. The primary outcome is cancer care disruptions evaluated by a blinded panel of oncologists. Secondary outcomes include patient and caregiver-reported outcomes and healthcare utilization. Barriers to Bridge implementation and dissemination are assessed using mixed methods. DISCUSSION This trial will inform efforts to systematically identify individuals with SMI and cancer and generate the first experimental evidence for the impact of person-centered collaborative care on cancer care for this underserved population.
Collapse
Affiliation(s)
- Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Catherine A Callaway
- Department of Psychology, University of California Berkeley, Berkeley, CA, United States of America
| | - Amy E Corveleyn
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Catherine R Pappano
- Department of Psychology, University of Colorado Denver, Denver, CO, United States of America
| | - Maura J Barry
- University of New England College of Osteopathic Medicine, Biddeford, ME, United States of America
| | - Keenae M Tiersma
- University of Washington Medical School, Seattle, WA, United States of America
| | - Zoe E Nelson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Lauren E Fields
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - William F Pirl
- Harvard Medical School, Boston, MA, United States of America; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - David P Ryan
- Harvard Medical School, Boston, MA, United States of America; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute of Health Policy, Massachusetts General Hospital, Boston, MA, United States of America
| |
Collapse
|
4
|
Irwin KE, Ko N, Walsh EP, Decker V, Arrillaga-Romany I, Plotkin SR, Franas J, Gorton E, Moy B. OUP accepted manuscript. Oncologist 2022; 27:518-524. [PMID: 35443045 PMCID: PMC9256021 DOI: 10.1093/oncolo/oyac069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
We define cancer equity as all people having as the same opportunity for cancer prevention, treatment, and survivorship care. However, marginalized populations continue to experience avoidable and unjust disparities in cancer care, access to clinical trials, and cancer survival. Racial and ethnic minorities, and individuals with low socioeconomic status, Medicaid insurance, limited health literacy, disabilities, and mental health disorders are more likely to experience delays to cancer diagnosis and less likely to receive guideline-concordant cancer care. These disparities are impacted by the social determinants of health including structural discrimination, racism, poverty, and inequities in access to healthcare and clinical trials. There is an urgent need to develop and adapt evidence-based interventions in collaboration with community partners that have potential to address the social determinants of health and build capacity for cancer care for underserved populations. We established the Virtual Equity Hub by developing a collaborative network connecting a comprehensive cancer center, academic safety net hospital, and community health centers and affiliates. The Virtual Equity Hub utilizes a virtual tumor board, an evidence-based approach that increases access to multi-specialty cancer care and oncology subspecialty expertise. We adapted the tumor board model by engaging person-centered teams of multi-disciplinary specialists across health systems, addressing the social determinants of health, and applying community-based research principles with a focus on populations with poor cancer survival. The virtual tumor board included monthly videoconferences, case discussion, sharing of expertise, and a focus on addressing barriers to care and trial participation. Specifically, we piloted virtual tumor boards for breast oncology, neuro-oncology, and individuals with cancer and serious mental illness. The Virtual Equity Hub demonstrated promise at building capacity for clinicians to care for patients with complex needs and addressing barriers to care. Research is needed to measure the impact, reach, and sustainability of virtual equity models for patients with cancer.
Collapse
Affiliation(s)
- Kelly E Irwin
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Naomi Ko
- Department of Medical Oncology, Boston Medical Center, Boston, MA, USA
| | | | - Veronica Decker
- University of Central Florida College of Nursing, Orlando, FL, USA
| | - Isabel Arrillaga-Romany
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Scott R Plotkin
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emily Gorton
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Beverly Moy
- Corresponding author: Beverly Moy, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9A, Boston, MA 02114, USA.
| |
Collapse
|
5
|
Callaway CA, Corveleyn AE, Barry MJ, Gorton EI, Nierenberg AA, Irwin KE. Lessons learned: Building a coalition to advance equity in cancer and mental health care. Psychooncology 2021; 30:2087-2091. [PMID: 34787348 DOI: 10.1002/pon.5852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/07/2022]
Affiliation(s)
| | - Amy E Corveleyn
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maura J Barry
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily I Gorton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Dauten Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
6
|
D'Alton P, O'Meara R, Langford S, McDonnell Z, Nuzum A, Murthy VE, Craddock F, Cogley C, McCormack D. Barriers to cancer care for people with significant mental health difficulties: What healthcare staff say? Psychooncology 2021; 30:2032-2038. [PMID: 34453853 DOI: 10.1002/pon.5790] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Despite similar rates in cancer morbidity, patients with comorbid significant mental health difficulties (SMHD) experience higher mortality rates. This population has largely been neglected in cancer care research. Little is known about how to improve cancer outcomes for patients with SMHD. The aim of this research is to explore the views of healthcare professionals concerning the provision of cancer care to individuals with SMHD in an Irish context. METHODS Semi-structured interviews were conducted with healthcare professionals (n = 28) providing care to people with SMHD and cancer. This included oncology and psychiatry consultants (n = 10); clinical nurse specialists (n = 8); clinical psychologists (n = 6); and medical social workers (n = 4). Data were analysed using thematic analysis. RESULTS Four overarching themes were generated from the data highlighting the challenges associated with healthcare provision for this cohort. The themes were: Fragmentation of Care, Healthcare Providers' Understanding of SMHD, Complex Nature of Presentation, and Specialised Care Needs. CONCLUSIONS The findings contribute to advancing our understanding of cancer care provision for patients with SMHD. They identify important barriers and facilitators to cancer care provision for this population from the perspective of healthcare professionals in Ireland. These findings will help to shape future research and contribute to improving the quality-of-care for people with SMHD and cancer.
Collapse
Affiliation(s)
- Paul D'Alton
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Rachel O'Meara
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Seán Langford
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Zoe McDonnell
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ann Nuzum
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Fiona Craddock
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Clodagh Cogley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Derval McCormack
- School of Psychology, University College Dublin, Dublin, Ireland
| |
Collapse
|
7
|
Irwin KE, Loscalzo ML. Witnessing unnecessary suffering: A call for action and policy change to increase access to psycho-oncology care. Psychooncology 2020; 29:1977-1981. [PMID: 33217067 DOI: 10.1002/pon.5599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Kelly E Irwin
- Department of Psychiatry,, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Center for Psychiatric Oncology and Behavioral Sciences,, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew L Loscalzo
- Department of Supportive Care Medicine, Sheri & Les Biller Patient and Family Resource Center,, City of Hope National Medical Center, Duarte, California, USA.,Department of Population Sciences, City of Hope National Medical Center, Duarte, California, USA
| |
Collapse
|
8
|
González-Rodríguez A, Labad J, Seeman MV. Schizophrenia and cancer. Curr Opin Support Palliat Care 2020; 14:232-238. [DOI: 10.1097/spc.0000000000000512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
9
|
Abramson JS, Irwin KE, Frigault MJ, Dietrich J, McGree B, Jordan JT, Yee AJ, Chen YB, Raje NS, Barnes JA, Davis B. Successful anti-CD19 CAR T-cell therapy in HIV-infected patients with refractory high-grade B-cell lymphoma. Cancer 2019; 125:3692-3698. [PMID: 31503324 DOI: 10.1002/cncr.32411] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jeremy S Abramson
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelly E Irwin
- Division of Psychiatric Oncology, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew J Frigault
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brianne McGree
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Justin T Jordan
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew J Yee
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Yi-Bin Chen
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Noopur S Raje
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey A Barnes
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Benjamin Davis
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|