Background
Cancer is the leading cause of death in Ontario (~30% all deaths). Despite recent technological, pharmacological, surgical and biomedical advances in cancer care some of the most vulnerable still experience high mortality rates. Care standards aim to enhance screening, treatment, and monitoring with guidelines aimed at decreasing overall disease burden. However, structured guidelines can also create barriers for some marginalized populations, specifically individuals living with severe mental illness (SMI).
Obesity, smoking, inadequate physical activity, unhealthy diet, and substance use, commonly observed also contribute to disproportionate cancer risk.
The nature, severity, and course of mental illness can seriously impact cancer care pathways, from screening, detection, treatment, follow-up, and prognosis. Cancer care in SMI presents unique syndemic challenges alongside individual and structural barriers, stigma, and adverse life experiences with ensuing poorer health outcomes.
The Cancer and Severe Mental Illness Project (CaSMIP) brings together an intersectoral alliance of community stakeholders and scholars to undertake a programme of applied research, implementation science, knowledge transfer and mobilization that is focused on improving the life chances of individuals with Severe Mental Illness (SMI). Many individuals with Severe Mental Illness (SMI) in the community currently experience a large number of social determinants of health that include poverty, poor quality of housing and unhealthy lifestyles that increase the risk of cardiovascular disease, diabetes and injuries. Some of these issues are compounded by intersectional challenges due to their gender, race and various degrees of disability. There are less pro-health lifestyles, lower rates of health literacy, help-seeking and completion of health screening processes with consequentially worse health outcomes. A proportion of these individuals with SMI also carry a significant comorbid illness burden and symptoms such as paranoia, which impair ability to consent to disease preventing and potentially lifesaving procedures. This ultimately leads to a worse prognosis, higher levels or morbidity and mortality because of lower rates of engagement with cancer preventative measures such as smoking cessation, exercise, healthy diet and screening among people with SMI. For example, research has found that SMI females are five-times less likely to have a pap smear; lower colorectal cancer screening among men and women; fewer chemotherapy and radiotherapy sessions and worse surgical outcomes than the general population. Mortality risk is between 2-2.5 times that of the general population for breast, colon and lung cancers (see Fig below) for individuals with schizophrenia. Furthermore, higher rates of fear, stigma, misunderstanding and discrimination faced by people with SMI in healthcare interactions compound their experiences.
Overarching Goals
Facilitate intersectoral and interprofessional collaboration involving, primary care, mental health services and oncology carepathways for individuals with an SMI and their families or caregivers.
Co-develop SMI guidelines for five specific and common cancers (lung, breast, colorectal, cervical and prostate) that intersect gender, sociodemographic risk factors, procedural and non-procedural screening.
Identifying and overcoming specific SMI and EDI barriers which affect screening, early diagnosis and treatment of each of the cancers.
Develop targeted preventative strategies for specific cancers with known risk factors e.g. sexual health, smoking and obesity.
Raise community awareness of the challenges of cancer among persons with SMI.
Attempt to alter the overall cancer trajectory, including diagnosis of cancer at early stages and reducing intervals between diagnosis and treatment.
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