The Invisible Dilemma of Cancer Patients: When Mental Illness Meets Cancer

Xiao Ming has been very troubled lately.

His uncle, Wang Dawei, was diagnosed with advanced lung cancer, and doctors said it would be six months at most. But what gave Xiao Ming's family a headache was that Wang Dawei suffered from severe schizophrenia, often hallucinating and delusional.

"My uncle was reluctant to cooperate with the treatment, always saying that the doctor wanted to kill him. We managed to convince him to be hospitalized, and he often ran out of the room in the middle of the night, yelling that he wanted to go home. Xiao Ming said helplessly, "The doctors and nurses don't know what to do, and our family is about to collapse." "

Uncle Ming's experience actually represents a special group of cancer patients - cancer patients who also suffer from serious mental illness. Their situation is often more difficult than that of ordinary cancer patients.

Today, let's take a look at this neglected group and see what special struggles they face and how healthcare workers can better help them.

1. Neglected groups: People with mental illness have a higher risk of cancer

When we think of people at high risk of cancer, we usually think of smokers, obese people, etc. But what you may not know is that people with severe mental illness are also at high risk of cancer.

Severe mental illness (SMI) mainly includes chronic and disabling mental disorders such as schizophrenia and bipolar disorder. Although SMI patients make up only a small percentage of the population, their health is often not encouraging.

Studies have found that the average life expectancy of patients with SMI is 10-20 years shorter compared to the general population. There are many reasons for this disparity, including increased risk of suicide, poor management of chronic diseases, etc. Cancer is one of the important causes of premature death in SMI patients.

Data show that SMI patients have higher rates of certain cancers than the general population:

• People with schizophrenia have a 90% higher risk of colon cancer
• People with bipolar disorder have a 2.6-fold higher risk of developing thyroid cancer
• Patients with major depressive disorder have a 1.7-fold higher risk of developing liver cancer

Why are SMI patients more likely to get cancer? Reasons include:

1. Unhealthy lifestyle: People with SMI are more likely to smoke, drink heavily, and lack physical activity, which are all risk factors for cancer.
2. Medication side effects: Some psychiatric medications may increase the risk of obesity and indirectly increase the risk of cancer.
3. Genetic predisposition: Certain genes may increase the risk of both psychiatric disorders and cancer.
4. Inadequate access to healthcare resources: Patients with SMI often have limited access to routine check-ups and cancer screenings.

Xiao Ming's uncle, Wang Dawei, is a typical example. He has suffered from schizophrenia for more than 20 years, has been a long-term alcoholic and smoker, rarely exercised, and never has a medical examination. It was not until the symptoms of coughing up blood that it was found to be an advanced stage of lung cancer.

2. Delay in diagnosis: When psychiatric symptoms mask cancer signals

Not only do patients with SMI have a higher incidence of cancer, but their cancer is often diagnosed with delays.

Studies have shown that patients with SMI tend to have more advanced cancer at the time of diagnosis compared to the general population. In the case of breast cancer, for example, 73% of patients with SMI are diagnosed at an advanced stage.

Why is this so? There are several reasons for this:

1. Symptoms are misunderstood

Physical discomfort in patients with SMI is often mistaken for psychiatric symptoms or medication side effects.

For example, if a person with schizophrenia has persistent abdominal pain, doctors may dismiss it as a hallucination and ignore the possibility of stomach cancer.

1. Communication barriers

Some people with SMI may have difficulty accurately describing how they feel or may not be willing to seek medical advice at all. This leads to the neglect of early symptoms of cancer.

1. Low willingness to seek medical care

Many SMI patients are reluctant to seek medical care due to distrust of the healthcare system or fear of discrimination.

1. Inadequate screening

Patients with SMI often struggle to maintain regular check-ups and cancer screenings, missing out on the opportunity to detect cancer early.

Wang Dawei's example is typical. He had a long-term cough, which his family thought was just a cold, and he was reluctant to go to the hospital until he coughed up blood. When he was finally diagnosed, he was already in the advanced stage of lung cancer.

3. Treatment dilemma: When drug interactions become an obstacle

For patients with both SMI and cancer, the treatment process is often more complex than for ordinary cancer patients.

First, drug interactions are a challenge.

Many chemotherapy drugs can interfere with the metabolism of psychiatric drugs and may worsen psychiatric symptoms. Conversely, some psychiatric drugs may also affect the effectiveness of chemotherapy drugs.

For example, risperidone, a commonly used antipsychotic, can reduce the effectiveness of certain chemotherapy drugs. Aprepitant, which is commonly used in chemotherapy, may affect the effectiveness of the antidepressant fluoxetine.

Second, side effects are trickier to manage.

Patients with SMI may have difficulty accurately describing side effects or mistake side effects for exacerbations of psychiatric symptoms. This poses a challenge for physicians to manage their symptoms.

Thirdly, treatment adherence tends to be poor.

Patients with SMI may have difficulty adhering to complex treatment regimens due to impaired cognitive function or lack of understanding of treatment.

Wang Dawei often refuses to take chemotherapy drugs, saying that they are "poison". It took a lot of effort for his family to convince him to continue treatment.

4. Psychological stress: When cancer meets mental illness

Cancer is a huge psychological stressor for anyone. But for people with SMI, this pressure can be even more overwhelming.

First, people with SMI often lack the ability to cope with stress. They may have difficulty adopting positive coping strategies and are more likely to fall into pessimism and despair.

Second, cancer may exacerbate pre-existing psychiatric symptoms. Anxiety and depression may become more severe and even trigger psychotic episodes.

Third, social support is often insufficient. Many people with SMI already have a limited social network and are even more isolated when it comes to facing cancer.

Finally, shame and self-stigma are also a big problem. Some people with SMI may perceive cancer as punishment for themselves and develop strong feelings of self-blame.

Wang Dawei often said: "It's not interesting for people like me to live, just let cancer take me away quickly." This negativity has seriously affected his motivation for treatment.

5. Hospice care: a neglected need

Studies have shown that patients with SMI have less access to palliative care and end-of-life care at the end of life than patients with common cancer.

Reasons for this disparity include:

1. Concerns of medical staff: Some healthcare professionals may be reluctant to accept patients with SMI who are concerned that they will disturb other patients.
2. Communication disorders: It can be difficult to discuss end-of-life intentions with patients with SMI.
3. Cognitive problems: Some patients with SMI may have difficulty understanding the concept of palliative care.
4. Inadequate social support: patients with SMI who lack family support may have difficulty accessing home-based end-of-life care.

As a result, many people with SMI suffer from the lack of proper symptom control and psychological support at the end of life.

Wang Dawei's family is facing such troubles. The local hospice said it had no experience in receiving people with mental illness and suggested that they send Mr. Wang to a psychiatric hospital. However, psychiatric hospitals lack expertise in palliative care for cancer. In the end, Wang Dawei could only stay in a general hospital and did not receive professional hospice services.

6. How to break the game? Multidisciplinary collaboration is key

In the face of these challenges, it is difficult for a single discipline to meet. We need close collaboration in many areas, including psychiatry, oncology, palliative medicine, etc.

Here are some possible areas for improvement:

1. Strengthen cancer screening

Consideration may be given to developing a dedicated cancer screening program for patients with SMI to improve the rate of early diagnosis.

1. Train healthcare workers

Mental health training for oncology health care workers to improve their ability to care for patients with SMI. At the same time, it is important to educate psychiatrists about cancer treatment.

1. Develop a personalized treatment plan

According to the characteristics of SMI patients, a more flexible and simplified treatment plan should be developed to improve compliance.

1. Strengthen psychological support

Dedicated psychological counselling for SMI cancer patients to help them better cope with the double whammy.

1. Development of specialized palliative care

Establish a special palliative care team for SMI patients to meet their specific needs.

1. Improve social support

Strengthen community support to provide essential care for isolated SMI cancer patients.

1. Promote policy support

We call on relevant departments to pay attention to this special group and formulate special medical policies.

Some hospitals have already started experimenting with innovative models. For example, a tertiary hospital has set up a "psychiatric oncology department", which is composed of a joint team of psychiatrists and oncologists to provide one-stop services for SMI cancer patients.

The results have been significant: patient adherence to treatment has increased, complication rates have decreased, and quality of life has improved significantly.

Wang Dawei was fortunate to be referred to this special ward. There, he not only received professional cancer treatment, but his mental symptoms were also well controlled. The most commendable thing is that the patient listening and support of the medical staff has rekindled his hope.

"I now look forward to getting better every day and want to make some more contributions to society." Wang Dawei said to Xiao Ming with a smile.

When a serious mental illness meets cancer, the challenges faced by patients are unimaginable. But that shouldn't be a reason for us to ignore their needs.

On the contrary, it should be the driving force behind us to improve our health services. Through multidisciplinary collaboration and innovative service models, we have the potential to provide better care for this special population, so that they can feel dignity and warmth in the final journey of life.

After all, caring for every life, regardless of background, is the essence of medicine.