Barriers in cancer trajectories of patients with pre‐existing severe mental disorders—A systematic review

Abstract

Background: Patients with pre-existing severe mental disorders are significantly less likely to receive guideline-recommended cancer treatment and seems to have a significantly lower rate of cancer survival compared to patients with cancer without mental disorders. Aim:To perform a systematic review on barriers at patient-, provider-and systemlevels in cancer trajectories of patients with pre-existing severe mental disorders.Method: A systematic review was performed following the PRISMA guidelines (PROSPERO ID: CRD42022316020).Results: Nine eligible studies were identified. Barriers at patient-level included lack of self-care and ability to recognize physical symptoms and signs. Provider-level barriers included stigma from health care professionals on mental disorders, whereas system-level barriers included fragmented health care and consequences of this. Conclusion:This systematic review found that barriers at patient-, provider-and system-levels exist in cancer trajectories for patients with severe mental disorders,This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Professionals’ perspectives on caring for cancer patients with pre-existing severe mental disorders

“…An interview guide was developed from existing literature [1,[6][7][8]12]. The open-ended questions included: challenges experienced, thoughts about the patient group, cooperation and communication with colleagues and improvement of care.…”

“…Several studies have emphasised mental disorder-related stigma among healthcare professionals as a barrier in cancer trajectories [1,[6][7][8]14]. Stigmatising attitudes in healthcare settings may be a result of misinformation and are known to potentially cause suboptimal healthcare and diagnostic overshadowing [7,8,15].…”

“…Studies have reported that healthcare professionals working with this patient population experience multiple care provision challenges, including a lack of knowledge about patients with both psychiatric and somatic conditions [6][7][8].…”

“…Only few studies have been conducted on experiences of healthcare professionals caring for patients with cancer and pre-existing SMD [6][7][8]. Furthermore, research conducted in a fully tax-financed healthcare system is lacking.…”

Interfaces between oncology and psychiatry

“…Only 10% of these persons are referred for mental health services, according to empirical evidence 3 – 5 . The problems of stigma and discrimination, poorer dignity, poorer health behavior, and lack of integration in health-care services for people with severe mental disorders need to be addressed and solved in cancer care 7 – 9 .…”