Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
Psychooncology. 2020 Oct;29(10):1445-1451. doi: 10.1002/pon.5534. Epub 2020 Sep 11.
Given the reported increased rates of physical morbidity and higher mortality rates among people with severe mental illness (SMI) (schizophrenia and severe mood disorders), with a life expectancy shorter of 15-20 years with respect to the general population, the aim of this paper was to call attention to the problem of cancer in SMI.
We conducted a narrative review of the most significant papers published in the areas of cancer screening, incidence, mortality and palliative care in SMI.
Data from the literature confirm disparities in screening (eg, mammography; pap-smear test; colorectal cancer screening) and prevention (eg, clinical breast examination; smoking cessation). The incidence of cancer was found to be variable with a portion of the studies reporting a higher prevalence while others a similar or a lower prevalence of cancer compared to the general population. A lower percentage of patients with SMI received proper cancer treatment resulting in survival after cancer diagnosis significantly worse than people without SMI. Likewise, end-of-life care has been shown to be lacking with poorer levels of physical, psychological and spiritual care.
The problems of stigma and discrimination, poorer dignity, poorer health behavior, lack of integration in health-care services for people with SMI needs to be addressed and solved in cancer care. Psycho-oncology has a very specific and mandatory role in integrating the recommendation of the World Health Organization to improve the links between oncology and mental health settings for more specific psycho-oncology programs addressed for this vulnerable segment of the population.
鉴于严重精神疾病（精神分裂症和严重情绪障碍）患者的身体发病率和死亡率较高，预期寿命比普通人群短 15-20 年，本文旨在关注精神疾病患者中的癌症问题。
我们对精神疾病患者癌症筛查、发病率、死亡率和姑息治疗方面发表的最重要文献进行了叙述性综述。
文献中的数据证实了筛查（例如乳房 X 线照相术；巴氏涂片检查；结直肠癌筛查）和预防（例如临床乳房检查；戒烟）方面的差异。癌症发病率存在差异，部分研究报告的发病率较高，而其他研究报告的发病率与普通人群相似或较低。接受适当癌症治疗的精神疾病患者比例较低，导致癌症诊断后的生存率明显低于无精神疾病患者。同样，临终关怀也存在不足，身体、心理和精神关怀水平较低。
在癌症护理中，需要解决和解决与精神疾病患者相关的污名和歧视、尊严较差、健康行为较差以及医疗服务整合不足等问题。心理肿瘤学在将世界卫生组织的建议整合到肿瘤学和精神卫生机构之间以改善针对这一弱势群体的特定心理肿瘤学计划的联系方面具有非常特殊和强制性的作用。
