Psychosocial Aspects of Oncology Screening

Question 1

What is Cancer

Answer 1

Any malignant growth or tumour caused by uncontrolled cell division

157,000 died of cancer in 2010 (22% lung cancer)

Question 2

Main risks of Cancer

Answer 2

Smoking (22% deaths from lung cancer)
Alcohol
Lack of exercise
UV Rays
Diet (red meat & sugar)

Question 3

The cancer journey

Answer 3

Prevention
Screening
Diagnosis
Treatment
Either or" end of life care or survivorship

Question 4

What factors can affect screening?

Answer 4

Low SES (Lo et al 2013;2015)
Non-White ethnicity (Sin et al 2009; Lo et al 2015)
Being Single & Younger age (Lo et al 2015).

Question 5

Social-cognitive impacts

Answer 5

Screening Knowledge

Social Norms

Ethnic differences

Martial status through norms.

Perceived barriers Bishop et al (2014) availability of quality services, facilities that lack comfort and privacy, costs,

Question 6

Factors to help understand mental illness and cancer prevention

Answer 6

Demographic Characteristics:
Age
Race
Insurance
Education

Genetic Predisposition

Social Determinants

Aggarwal et al, (2013)

Question 7

Utilisation of Screening & Mental Ilness

Answer 7

Psychosis (Tilbrook et al, 2010)
Schizophrenia (Martens et al, 2009)

Fewer mammograms if:
Depression (Masterson et al 2010; Pirraglia et al 2004)

Not psychiatrically hospitalized (Long et al, 1998)

But they have higher health care utilisation (Tilbrook et al 2010)

Low severity mood disorder 7% less likely to have mammogram than general population (Carney & Jones, 2006)

High 66% less Likely (Carney & Jones, 2006)

Psychotic and substance use disorder: low screening (Carney & Jones, 2006)

Question 8

Barries to Screening: Patients Perspectives (Clifton et al, 2016, Miller et al 2007; Owen et al 2002) System Barries

Answer 8

Transportation Problems

Long wait times/ lack of reminders

Question 9

Barries to Screening: Patients Perspectives (Clifton et al, 2016, Miller et al 2007; Owen et al 2002) Healthcare Professional Barriers

Answer 9

Poor relationship with GP

Question 10

Barries to Screening: Patients Perspectives (Clifton et al, 2016, Miller et al 2007; Owen et al 2002) Individual Barriers

Answer 10

Beliefs about the dangers of screening

Shame & embarrassment

Fear of adverse findings

Fear of procedure - fear of pain, coldness, compression on breast (Khan et al 2005)

Gender of health provider recommending (Owen et al 2002 & Kahn et al, 2005)

Question 11

Facilitators to screening: Patient Perspectives (Clifton et al 2016) Social

Answer 11

Family & Friends
Positive relationship with GP
Previous experience
Familiar Location

Family History of Cancer.

Question 12

Barriers to screening: primary care professional perspectives Mental Ilness(Miller et al 2007)

Answer 12

Lack of time

Preventive care not prioritised (relative to active disease process)

Relationship to mental health providers

Lack of knowledge of mental illness

Question 13

Barriers to screening: Mental health providers perspectives

Answer 13

Lack of patient understanding about benefits of preventive screening

Balance of autonomy vs beneficence
(doctors does not know the persons own body, however they can advise what is best for the patient.

Question 14

What can be done to encourage uptake

Answer 14

Individualised care

Interventions

But: Barley et al (2016) no trials aimed at increasing cancer screening among people with mental health issues.

Question 15

Cancer Treatments

Answer 15

Chemotherapy

• Stops cancer cells reproducing
• Effect other cells (digestive system
• Adjuvant Chemo - given after surgery to stop cancer coming back.

Radio -

• External & Internal
• Destroys cancer cells in area treated

Immunotherapy
Attaching specific proteins of cancer cells
Triggers immune system
To destroy cells
Led to increased survival rate

Question 16

Depression Wurtman 2017

Answer 16

Depression can lead to Social Isolation, 66% of people with mental illness report feeling socially isolated compared with about 10% of the general population.

Link to encouragement from friends family and peers.

Question 17

Psychosis Tilbrook 2010

Answer 17

More likely to smoke
Have more appointments
More likely to miss them
5 times less likely to receive adequate PAP screening.

Question 18

Schizo Martens 2010

Answer 18

Those in low income area less likely to get screening, good community care increase likelihood

Question 19

Shan 2006

Answer 19

Psychological Distress from false positive mammograms, more likely to report anxiety and depression.

Question 20

American Cancer Society

Answer 20

False positive look abnormal but no cancer present.
Highest for first mammogram
Common for people who are younger