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Mental health patients face barriers to cancer treatments

Three researchers have examined the barriers to health experienced by B.C. cancer patients who have also experienced mental illness.

Three researchers have examined the barriers to health experienced by B.C. cancer patients who have also experienced mental illness.

The researchers presented the findings of their study on Thursday during a noon-time presentation at the University Hospital of Northern B.C. The researchers focused their study on nine individuals who had received a cancer diagnosis and who were also mental health service users. The identities of the individuals were kept confidential. The study was funded by a seed grant provided by UNBC's Health Research Institute.

The qualitative study found that some individuals experienced no difference in their cancer care, while others experienced significant barriers to care and wellbeing related to financial constraints, stigma and feelings of social isolation.

According to Nansi Long, one of the researchers and a coordinator with Prince George's Activity Centre for Empowerment, the study grew out of a previous study initiated by UBC and the UNBC Northern Medical Program. This study focused on finding out what programs mental health patients believed would help improve their own health. Through the course of this research, Long found the prevalence of cancer amongst her study participants to be alarmingly common.

"We actually lost a number of participants, or a number of participants had to discontinue their participation in the study due to cancer. We lost a number of participants due to death from cancer," Long said.

According to Michelle Waller, a psychiatry resident at UBC, one in five Canadians experience mental illness over the course of their lifetimes. Of those, 10 per cent access specialized psychiatric services. A significantly high number of mental health service users have above-average rates of cancer.

Waller said cancer rates have been shown to be between 17 and 29 per cent higher than average for individuals experiencing severe mental illness. Lung cancer rates are 31 per cent higher than the Canadian average for mental health service users.

Northern B.C. is projected to have the largest increase in cancer diagnoses over the next decade, according to Waller.

Roseann Larstone, a research associate with the Northern Medical Program, said service users identified several gaps in support services while they were undergoing cancer treatment. Several participants identified support with daily activities, such as shopping and maintaining a household while undergoing physically draining treatments, to be an area in need of improvement.

Other patients spoke of difficulties related to their contact with health professionals. One individual believed health professionals were more "on guard around me," suggesting that stigma still exists in the medical sphere. Other individuals said they felt they were treated fairly, exactly like other patients by medical professionals. Still others pointed to difficulty in understanding medical terminology and jargon when it came to treatments and diagnoses.

"Multiple participants spontaneously expressed that they experienced differences in receiving cancer care versus mental health care, with one observing 'I'm quite surprised at how differently we treat people with cancer as compared to people with mental illness,'" Larstone said in her presentation.

"For us that highlights aspects of stigma that we identified in our previous work and certainly shown in the work of other researchers."

Larstone said some individuals felt health care providers looked at mental illness as being a condition that was simply more difficult to deal with than cancer.

"Patients with cancer and mental illness often face perceptions that they are 'difficult patients' who may lack the capacity to make treatment decisions and also adhere to treatment regiments."

On a broader scale, Larstone said issues of poverty and social isolation must be addressed on a governmental level in order to improve the health outcomes in individuals with mental illness.

"To adequately address this aspect, as my colleagues note, anti-poverty measures such as affordable housing, healthy food assistance programs and programs that support opportunities for mainstream employment for people with disabilities are what is ultimately needed," she said.

Long suggested the care of mental health service users could be improved by a number of practices. She suggested that clear communication related to diagnoses should be shared between physicians and mental health care providers, such as psychiatric nurses or social workers. More education of family members as to the effects of cancer treatments could also help alleviate some of the anxiety and stress experienced by mental health service users. Peer-led programs were also identified as an important element for improving care. Finally, written guidelines for treatment could improve communication with patients.

"Writing things down for patients to take with them is a really and easy way," Long said.