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Cancer & Severe Mental Illness – mind the gap A Program for Psychiatric Patients in a Portuguese Cancer Center ID: AOS5-3
Presenter Lucia Monteiro, MD, Director, Psychiatry Service, IPO Lisboa
On behalf : A Ribeiro, R Coutinho, J Graça, M Mestre, F Carvalho (aa)
Instituto Portugues Oncologia, Lisboa, Portugal
Instituto Portugues Oncologia Lisboa Abstract published before NO; data presented before YES
No disclosure of interest
WCC - Track 2 Closing the gap: quality cancer treatment and diagnosis for all Inequities in cancer care 03 Nov 2016
Background - bibliografic references 606 reviewed articles, Pub Med, ACS database, 2006-2016 key words: cancer diagnosis, cancer prevention, cancer tratment, severe mental illness
• 1.Caldas de Almeida J. M. Xavier M. Estudo Epidemiológico de Saúde Mental em Portugal. Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 2013.
• 2.Health National Institute of Mental Serious Mental Illness (SMI) Among U.S. Adults [Online]. - 2014. - http://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml.
• 3. Marc De Hert, Christoph U. Correll, Physical illness in patients with severe mental disorders. Prevalence, impact of medications and disparities in health care, World Psychiatry 2011;10:52-77
• 4. Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry 1998;173:11-53.
• 5.Osby U, Correia N, Brandt L et al. Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. BMJ 2000; 321:483-4.
• 6.McGinty EE, Zhang Y, Guallar E, Ford DE, Steinwachs D, Dixon LB, Keating NL, Daumit GL. Cancer incidence in a sample of Maryland residents with serious mental illness. Psychiatr Serv. 2012 Jul;63(7):714-7. doi: 10.1176/appi.ps.201100169.
• 7.de Leon, J., Becona, E., Gurpegui, M., Gonzalez-Pinto, A., Diaz, F.J., 2002. The association between high nicotine dependence and severe mental illness may be consistent across countries. Journal of Clinical Psychiatry 63 (9), 812–816.
• 8.National Institute of Drug Abuse. Topics in brief: comorbid drug abuse and mental illness. 2007. www.drugabuse.gov/publications/topics-inbrief/ comorbid-drug-abuse-mental-illness
• 9.Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. JAMA 1990;264(19):2511–8.
• 10.Simon GE, Von Korff M, Saunders K et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006;63:824-30.
• 11.Gracious BL, Cook SR, Meyer AE et al. Prevalence of overweightand obesity in adolescents with severe mental illness: a crosssectional chart review. J Clin Psychiatry 2010;71:949-54.
• 12. Werneke, U., Taylor, D., Sanders, T.A.B., Wessley, S., 2003. Behavioural management of antipsychotic weight gain: a review. Acta Psychiatrica Scandinavica 108, 252–259.
• 13.Carney CP and Jones LE. The influence of type and severity of mental illness on receipt of screening mammography. J Gen Intern Med 2006; 21: 1097–1104.
• 14.O’Rourke RW, Diggs BS, Spight DH, Robinson J, Elder KA, Andrus J, Thomas CR, Hunter JG, JObe BA. Psychiatric illness delays diagnosis of esophageal cancer. Diseases of the Esophagus. 2008; 21. 416-421
• 15.Druss BG, Bradford DW, Rosenheck RA, Radford MJ and Krumholz HM., Mental disorders and use of cardiovascular procedures after myocardial infarction. J Am Med Assoc 2000; 283: 506-51113.Piatt, M. Munetz,C. Ritter; An examination of premature mortality among decedent with serious mental illness and those in the general population Psychiatr Serv, 61 (7) (2010), pp. 663–668
• 16.Piatt, M. Munetz,C. Ritter; An examination of premature mortality among decedent with serious mental illness and those in the general population Psychiatr Serv, 61 (7) (2010), pp. 663–668
• 17.Lawrence D, Kisely S. Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology. 2010;24(11, Suppl 4):61-8. PMID: 2010-23457-008.
• 18. Swinson Evans T, Berkman N, Brown C, Gaynes B, Palmieri Weber R. Disparities Within Serious Mental Illness. Technical Brief No. 25. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2015-00011-I). AHRQ Publication No.16-EHC027-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2016. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
• 19.https://www.omh.ny.gov/omhweb/guidance/serious_persistent_mental_illness.html
• 20. Farasatpour M, Janardhan R, Williams CD, Margenthaler JA, Virgo KS, Johnson FE. Breast cancer in patients with schizophrenia. 2013 (206, 5): 798–804 (….)
cancer & Severe Mental Illness – mind the gap a program for Psychiatric Patients in a Portuguese Cancer Center
“Severe mental illness” (SMI), group of mental disorders that:
Often includes schizophrenia, schizoaffective, bipolar disorders, severe forms of delusional, personality and obsessive-compulsive disorders
Usually affect people in early adulthood have a profound negative impact in terms of disability and quality of life
The estimated worldwide prevalence of SMI is 4% (1,2)
There is strong evidence that SMI adults have two to three times higher mortality than the general population = less 13-30 years of life expectancy (3-5)
Medical mortality among SMI pts is mostly due to cardiovascular and cancer (2-5x higher risk in SMI)
Cancer & Severe Mental Illness – mind the gap a program for Psychiatric Patients in a Portuguese Cancer Center
Risk factors for Cancer in SMI pts:
tobacco use (the single largest causative factor) (7)
alcohol &drug abuse
poor self-care
promiscuous sexual behavior
viral infections (8,9)
poor diet, less exercise, obesity (10-12)
Cancer & Severe Mental Illness – mind the gap a program for Psychiatric Patients in a Portuguese Cancer Center Inequalities of SMI cancer care & prevention: the gap…
low self-care and low health literacy deficient compliance with GPs’ routines and screenings
psychiatrists often underestimate their responsibility and pivotal role in SMI pts general health somatic complaints are often underestimated for psychogenic attribution in psychotic pts (13-15)
fragmentation of health care systems: primary care, psychiatric & oncological services deficient cancer screening, late oncological diagnosis (16,17 ),
simplification of oncologic treatment protocols, often less accurate (14)
Instituto Portugues de Oncologia , Lisboa (IPO Lisbon) , main comprehensive cancer center in Portugal, 287 beds, 6500 new pts per year; 47.000 first outpatient consultations in a total of 260.000.
IPO Lisbon’s Psychiatry Service (Psychiatry S), 5 senior psychiatrists plus residents providing: - psychiatric assistance to cancer hospitalized /outpatients /their families - intensive Consultation Liaison Psychiatry within multidisciplinary oncological teams
What´s about SMI & Cancer pts in our Cancer Center in 2016? observational, prospective study, data from SMI pts referred to Psychiatry S from all other Services,
whether outpatient or hospitalized, in the last 8 months (Jan-Aug 2016) fulfill 3 criteria: (1) 18 years or older ; (2) suffering from a Serious and Persistent Mental Illness
(New York State Office of Mental Health criteria) (19) (3) suffering from an oncological illness undergoing treatment or follow up in IPO Lisbon
characterization focused on socio-demographic, psychiatric and oncological data n = 33 pts enrolled
Cancer & Severe Mental Illness – mind the gap a program for Psychiatric Patients in a Portuguese Cancer Center
Sociodemographic´s n=33 (100%)
Gender Male Female
33% 67%
Age – years Median sd
57 12,4
Civil state Married Divorced Single Widow
46% 15% 33% 6%
Employment Active Unemployed Never worked Retired
18% 24% 9% 49%
GAF score Global Assessment of Functioning
0 2 4 6 8
11 a 20
21-30
31-40
41-50
51-60
61-70
71-80
number of patients
GAF
scor
e
32%
12% 20%
18%
18%
Hematological
Urogynecologic
Breast
Head & Neck
Others
n=33
33%
24% 5%
19%
5% 9%
5%
I
II
IIa
III
IIIb
IV
IVa
n=21 Cancer Site Tumor staging solid tumors
62% (I + II) localized cancer
Psycho-Oncologic Program for SMI pts with Cancer treated in IPO Lisbon, 2017 :
immediate referral to psycho-oncology clinic on admission
providing a case manager or navigator when family is missing or not supportive
referral to tobacco and nutrition clinics when necessary
education for Oncology teams focused on screening, communication & coping with SMI pts
education in regional Psychiatry Centers (Lisbon area) and Primary Care Units (IPO referral to PC Units) focused on cancer risks & how to prevent and screen cancer in SMI pts.
…. In order to reduce the gap & inequities in cancer care for people with severe mental illness
Cancer & Severe Mental Illness – mind the gap a program for Psychiatric Patients in a Portuguese Cancer Center
Research funding –none
Thank You
www.luciamonteiro.com www.ipolisboa.pt