Tuesday, August 29, 2023

Patients With Mental Illness May Not Receive Cancer Symptom Screening

Cancer patients with major mental illness are less likely to be screened for common cancer symptoms such as pain and fatigue than cancer patients without a major mental illness, suggests a report in Psycho-Oncology.

“There is evidence that patients with [major mental illness] are at a greater risk for delayed cancer diagnosis, experience unequal standards of care, and generally poorer disease outcomes due to a constellation of patient, provider, and health care system factors,” wrote Laura E. Davis, a Ph.D. student at McGill University; Alyson Mahar, Ph.D., of ICES in Toronto; and colleagues. Routine cancer symptom screening can help to identify the most severe symptoms experienced by patients and encourage discussion between patients and their doctors about how best to treat these symptoms, the authors continued.

For the study, Davis, Mahar, and colleagues relied on information collected in several databases to identify adults in Ontario who were diagnosed with cancer between January 1, 2007, and August 31, 2020. The researchers separated these patients into two groups: those with major mental illness (diagnosis of major depression, bipolar disorder, schizophrenia, and other psychotic illnesses five years before the cancer diagnosis) and those without major mental illness. They then tracked evidence of symptom assessments of these patients—from cancer diagnosis until death or end of study date (August 31, 2021), whichever occurred first. The researchers focused on two main outcomes: time to cancer symptom screening using the Edmonton Symptom Assessment System (ESAS-r) and time to severe symptom score.

The final cohort consisted of 4,049 patients with major mental illness seen in an inpatient setting, 9,775 patients with major mental illness seen in an outpatient setting, and 376,046 patients without a major mental illness diagnosis or use of mental health services in the five years to six months before cancer diagnosis.

Compared with those without a major mental illness, those with major mental illness were less likely to have an ESAS-r recorded, reported Davis, Mahar, and colleagues. They were also more likely to report a high symptom score across all nine ESAS-r symptoms.

“Notably, individuals with [a major mental illness] were more likely to report moderate-to-severe symptoms of nausea and pain, where well-defined management protocols exist,” the authors wrote. “This highlights the need for both improved access to symptom screening and management strategies for cancer patients with a pre-existing mental illness to provide appropriate support, optimize outcomes, and deliver equitable cancer care.”

For related information, see the Psychiatric Services article “Association Between the Maryland Medicaid Behavioral Health Home Program and Cancer Screening in People With Serious Mental Illness.”

(Image: iStock/Ridofranz)

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