Lowering cancer deaths in patients with mental illness
People who suffer problems with their mental health also face higher risks of cancer and death. The reasons behind this are multifarious and interconnected, explains Igor Grabovac(opens in new window), specialist physician in public health at the Medical University of Vienna(opens in new window). “We generally think about them at three levels: individual risk factors and health behaviours, healthcare provider-level barriers, and broader systemic barriers,” he says. These include: increased exposure to cancer risk factors such as smoking; ‘diagnostic overshadowing’ – cognitive biases within health services that attribute physical symptoms with psychiatric conditions; and fragmented mental and physical healthcare systems. “These different factors interact and accumulate, creating inequities not only in exposure to cancer risk factors, but also in access to prevention, early detection and care,” explains Grabovac. To address some of these inequalities, the EU-funded CO-CAPTAIN(opens in new window) project developed a patient navigation intervention designed specifically for people experiencing mental health problems. “The aim was not only to provide accessible information about cancer prevention, but also to support people in reaching and using relevant services and to help them make informed decisions and act on their own health priorities,” adds Grabovac.
Co-designing a patient navigation intervention
The first step was to co-design interventions, starting with qualitative interviews with people with lived experience, caregivers, family members and professionals to map out what barriers and facilitators people face. Co-designed workshops in four pilot countries then helped to define specific interventions, what they will do, and how they should be best implemented in the context of each country. Navigators were then trained and placed in mental health-related institutions across Europe, such as hospitals, outpatient clinics and non-governmental organisations. Participants and navigators then jointly identified individual prevention goals, and the navigator provided practical and motivational support. “Importantly, this was not a one-off interaction,” remarks Grabovac. “Navigators remained in regular contact with participants, helped maintain motivation, supported access to relevant services and worked with them to overcome barriers when difficulties arose.”
Observing positive changes in cancer risk, health and health literacy
The research identified several key findings, including experiences consistent with diagnostic overshadowing within European health and social care settings in four pilot sites. “This is an important reminder that reducing cancer inequalities is not only about changing individual behaviour,” says Grabovac. “We also need to ensure that the physical health concerns and prevention needs of people experiencing mental health problems receive the same attention as those of any other patient.” The findings from the patient navigation intervention were also very encouraging. “We observed positive changes in several cancer risk-related health behaviours, alongside improvements in self-reported health and health literacy,” adds Grabovac. The researchers also saw improvements in mental health symptoms, suggesting engaging with cancer prevention can contribute more broadly to patient health and well-being.
Supporting cancer prevention and mental health improvement across Europe
The project’s work with stakeholders identified key gaps in service provision, lessons which were translated into targeted policy recommendations. These insights are already informing health services in Austria, Poland and Spain. The team also developed a new tool for policymakers and other organisations, which simulates expected outcomes from various approaches among different subgroups of people experiencing mental health problems. The ultimate hope is to contribute to a broader change in how cancer prevention is understood, notes Grabovac. “If we want cancer prevention to benefit the whole population, health systems need to recognise the additional barriers faced by underserved groups and provide appropriate support to overcome them.”
