Cancer and mental health – a clinical and research unmet need
A. Purushotham, S. Bains, G. Lewison, G. Szmukler & R. Sullivan
The diagnosis and treatment of cancer have a significant impact on mental health, and are associated with a physical, emotional and financial burden both on individuals and on society as a whole. Both these major non-communicable diseases have close interdependencies. Nevertheless, their clinical and research communities have traditionally not worked together much. This view has recently been reinforced by a report from the King’s Fund and Centre for Mental Health.
Mental health problems are the largest single source of disability in the UK, and co-morbid health problems raise total health care costs significantly. The King’s Fund report found that for patients with co-morbid mental health problems and physical illness, health care costs were raised by at least 45% per person, and amounted to an annual total of between £8 and £13 billion in England in recent years.
Most research into cancer and mental health has focused on the effects of cancer on patients’ mental health, specifically depression and anxiety, with evidence suggesting that co- morbidity of depression with cancer has a negative impact on physical morbidity and mortality. In patients with pre- existing mental health problems, the question arises whether there is an increased or decreased incidence of cancer, and if the overall outcome is affected by their mental state. On the other hand, these patients often present with more advanced disease because they are less likely to attend routine screening clinics. Given the impact that both these areas of morbidity can have on individuals and on society, one might expect there to be substantial research effort to investigate their interaction.
The study presented in this article provides the first high-resolution, objective study of where current areas of overlap and weakness are in the mental health cancer R&D domains; thus providing a major intelligence source for policymakers wishing to bridge this important trans-disciplinary boundary. The intention was to determine the scale of such research and to identify areas of strength and weakness with a view to identify where policies could be developed that would fill research lacunae in this complex interdisciplinary area.