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    Cancer diagnosis in people with mental illness

    Cancer diagnosis in people with severe mental illness: practical and ethical issues
    Lancet Oncology (August 2010), 11 (8), pg. 797-804

    Summary

    There has been increasing recognition of the high physical morbidity in patients with severe mental illness, but little has been written about cancer in these patients. Therefore, we review the published work on risk of cancer in patients with severe mental illness, treatment challenges, and ethical issues. Severe mental illness is associated with behaviours that predispose an individual to an increased risk of some cancers, including lung and breast cancer, although lower rates of other cancers are reported in this population. Severe mental illness is also associated with disparities in screening for cancer and with higher case-fatality rates. This higher rate is partly due to the specific challenges of treating these patients, including medical comorbidity, drug interactions, lack of capacity, and difficulties in coping with the treatment regimen as a result of psychiatric symptoms. To ensure that patients with severe mental illness receive effective treatment, inequalities in care need to be addressed by all health-care professionals involved, including those from mental health services and the surgical and oncology teams.

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    Re: Cancer diagnosis in people with severe mental illness: practical and ethical issu

    although lower rates of other cancers are reported in this population
    And there may be genetic reasons for that:

    http://forum.psychlinks.ca/schizophr...new-clues.html

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    Re: Cancer diagnosis in people with severe mental illness: practical and ethical issu

    Cancer death rate 65% higher among the mentally ill
    Andre Picard, Globe and Mail
    Jan. 13, 2009


    People suffering from mental illness have a death rate from cancer that is 65 per cent higher than others in the general population, according to new Canadian research. And the higher mortality rate exists even though those with mental illness are not significantly more likely to develop cancer, the research team found. While the data do not explain why the death rate is so much higher, researchers believe the most likely culprit is stigma: that health professionals are failing to see beyond mental health to diagnose physical ailments in a timely manner, even grave ones such as cancer.

    People suffering from mental illness have a death rate from cancer that is 65 per cent higher than others in the general population, according to new Canadian research. And the higher mortality rate exists even though those with mental illness are not significantly more likely to develop cancer, the research team found. While the data do not explain why the death rate is so much higher, researchers believe the most likely culprit is stigma: that health professionals are failing to see beyond mental health to diagnose physical ailments in a timely manner, even grave ones such as cancer.

    "The results are shocking," Joseph Sadek, a psychiatrist at Dalhousie University and co-author of the research, said in an interview. "Stigma is still a very big problem. It interferes with the doctor-patient relationship and with care," he said. The research, published in the Canadian Journal of Psychiatry, was designed to examine the link between mental illness and cancer. Much has been published on the topic, but the research is often contradictory.

    The existence of a universal health-care system and province-wide databases, however, allows for such studies to be done on a massive scale in Canada. In this case, researchers compared the records of patients treated for mental health problems in Nova Scotia from 1995 to 2001 with those treated for cancer in the same period.

    There were almost 247,344 people treated for mental health problems in the province during that time, about one in four residents. Of that total, 4,690 were diagnosed with cancer. On the whole, cancer incidence rates were about the same among mental health patients and those in the general population. There was, however, significantly more lung cancer and more brain cancer among mental health patients.

    Dr. Sadek said that, at the outset, researchers expected to see far more cancer in psychiatric patients than in the general population, in large part because many live in poverty and make poor lifestyle choices, such as smoking. What they did not expect was the dramatically higher mortality rates among mental health patients - 72 per cent in men and 59 per cent in women - who have the same risk of dying as everyone else.

    "The real question to emerge from this research is: Why are people dying?" Dr. Sadek said.

    He said that in Canada's universal health-care system, everyone should have the same access to care, at least in theory. But researchers believe that people with mental health problems who develop cancer are less likely to be screened and diagnosed, and are more likely to experience delayed treatment. "This is a population that doesn't complain much about their physical ailments. They have other problems," Dr. Sadek said.

    He said the research results should serve as a message to physicians to make extra efforts to probe the physical health of their mental health patients. About three million Canadians suffer from mental health problems at any given time.

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    Re: Cancer diagnosis in people with mental illness

    People with mental illness less likely to get cancer screening - Reuters

    In a review of 47 previous studies covering 4.7 million people in 10 countries, the study team found that adults with mental health issues were 24% less likely overall to get screened for cancer compared with the general population.

    The disparities were greatest among women with schizophrenia, who were roughly half as likely as women in the general population to be screened for breast cancer.

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