People with significant mental health difficulties are dying earlier and more frequently from cancer because they are less likely to receive the care they need and are excluded from clinical trials, according to experts who addressed the Irish Cancer Society public talk ‘Decoding Cancer: Bridging the Gap between Cancer and Mental Health’.
Dr Kelly Irwin, an instructor in psychiatry at Harvard Medical School, outlined the inequities people with these difficulties face when they are diagnosed with cancer and highlight potential solutions.
Dr Paul D’Alton, Head of the Department of Psychology at St Vincent’s University Hospital, Dublin, also explained how these inequities can be addressed in Ireland by establishing core Psycho-Oncology services, as set out in the National Cancer Strategy (2017-2026).
Both speakers highlighted the fact that people with difficulties such as schizophrenia, bipolar disorder, and severe depression are dying between 15 and 30 years earlier than the general population, prompting Dr Irwin to describe this as a “human rights violation”.
Four out of five of these deaths are due to medical causes, and cancer is the second leading cause of death.
This year 40,000 people in Ireland will hear the words ‘you have cancer’ and six in 10 of these patients will survive the disease for at least 5 years.
However, people with significant mental health difficulties are two to four times more likely to die from breast, colorectal, head/neck, and lung cancers, partly due to delayed diagnosis, less access to treatment, and fewer referrals to palliative care.
Dr Irwin also noted that this group of people is excluded from half of all clinical trials, yet with modified trial procedures they could be successfully participating in cancer trials.
Dr Irwin commented: “The gap between cancer and mental health is an inequity that is often unspoken. When it comes to advances in cancer care, we’re leaving a large group of people behind. But it doesn’t have to be this way.
“New research shows how we can bridge the gap with early, systematic integration of mental health and cancer care. For example, there is now evidence that access to psychiatry at the time of cancer diagnosis appears to promote equitable cancer care for people with schizophrenia.
“My work at Massachusetts General Hospital shows that individuals can participate in clinical trials. Collaborative care is a promising approach to improve treatment outcomes”, she added.
In Ireland, the new National Cancer Strategy aims to address such discrimination through establishing dedicated services for the psycho-social needs of people living with cancer, including those with significant mental health difficulties, in each cancer centre in the country.
Dr D’Alton stated: “Currently, only two of our eight designated cancer centres have a dedicated Psycho-Oncology service, even though it was one of priorities outlined in the previous National Cancer Strategy back in 2006. Clearly, this is not good enough.
“The cancer treatment journey is a difficult one, but it becomes even more difficult when the mental health issues that can arise are not sufficiently addressed”.
He stated that the new National Cancer Strategy needed to be acted upon “without delay”, emphasising that the Irish health service must be fully equipped to care for the needs of not only cancer patients, but also of people who have recovered from cancer, particularly the psychological impact resulting from treatment side-effects.