Cancer Prevention Approaches for People with Mental Illnesses and Addictions

Transcription

1 Cancer Prevention Approaches for People with Mental Illnesses and Addictions December 16 th, :30 3:00pm Eastern Rebecca Selove, PhD, MPH Research Associate Professor Tennessee State University Mandi Pratt-Chapman, MA Director George Washington University Cancer Institute

2 How to ask a question The best way to ask a question is to use the question box in your GoToWebinar window. We will have a brief Q&A session following the presentation.

3 Cancer Prevention Approaches for People with Mental Illnesses and Addictions National Behavioral Health Network Webinar December 16, 2014 Rebecca Selove, Ph.D., M.P.H Acknowledgement: Supported by Grant 5U54CA from the National Cancer Institute (NIH) Center for Prevention Research Tennessee State University

4 Objectives Describe the cancer control continuum. Provide context for review of research related to cancer along the continuum among individuals with SMI and/or SUD. Discuss examples of relevant research. Build case for active involvement and advocacy by behavioral health care providers and organizations in addressing cancer-related disparities among clients you serve. Offer specific patient-related and research activities you can provide or support, and suggest avenues for obtaining funding for this work.

5 Poll 1

6 Cancer numbers for the general population Over 1.6 million people in the US are likely to be diagnosed with cancer in (NCI) Approximately 586,000 people in the US will die of cancer this year. (NCI) 43% of men and 38% of women are at risk for developing some kind of cancer during their lifetime. (NCI, ACS) Another way of looking at the numbers New cases = 460/100,000/year Deaths from cancer= 174/100,000/year (ACS) (Cancer accounts for 24% of deaths from all causes - 741/100,000/year)

7 Number of individuals 12 years and older with mental health issues in the last year SAMHSA (2014)

8 Substance use disorders in the past year among individuals 12 years and older SAMHSA (2014)

9 Cancer incidence and mortality among people with SMI/SUD? Parks et al. (2006): persons with serious mental illness (SMI) are now dying 25 years earlier than the general population. The percent of people receiving mental health services who died from cancer was less than that of people in the general population perhaps because people [with mental illness] tended to die before reaching the age of greatest risk for death from cancer. Specific cancer incidence and mortality varies within population of individuals with SMI/SUD, with some sub-groups faring much worse than others.

10 Numerous confounders in relationship between cancer, SMI and SUD Age Parity Menopausal status Contraception history Obesity Smoking history Dietary history Alcohol use Housing status Family history Personal medical history Cognitive functioning Access to health care services Comorbidities Physical activity Environmental factors Poll 2

11 Although this model represents contributors to incidence of a specific kind of cancer, and not survival, it illustrates the complexity of contributors to incidence of various cancers and survival. Hiatt et al. (2014)

12 Tobacco use PREVENTION: Address risk factors for cancer. Certain infections (vaccination) Hepatitis B Human papillomavirus Alcohol consumption Obesity Physical inactivity Nutrition

13 Tobacco use among people with mental illness Based on the National Health Interview Survey 2007, from McClave (2010)

14 Alcohol consumption and RR of cancer (12 oz. beer, 5 oz. wine, or 1.5 oz. hard liquor = grams of alcohol) Cancer site No. of studies No. of cases 25 g/day 50 g/day 100 g/day Oral cavity 26 7, Esophagus Males Females Liver Males Females ,239 3, , Colon 17 5, Stomach 16 4, Female breast 49 44, Bagnardi et al. (2000)

15 SCREENING: USPSTF Guidelines Breast cancer BSE, mammograms starting at age 40 every 1-2 years Colorectal cancer beginning at age 50, various options Cervical cancer PAP test years, every 3 years Lung cancer: High risk = y.o., history of 30 pk./year Prostate cancer starting at age 50, based on conversation w/pcp General cancer-related annual physical exam, based on individual s personal and family medical history: Thyroid Oral cancers Skin cancers Testes and ovaries

16 Are depression & anxiety diagnosis associated with delay in resolution of abnormal screening? Kronman et al. (2011) looked at medical records of women who received abnormal results from screening for breast and cervical cancer to see if depression and anxiety were associated with delays in resolution. Of 523 women with abnormal mammogram and 474 women with abnormal Pap test, 17% had depression DX and 8.5% had anxiety DX. There was no significant difference in time to diagnostic resolution for either women with abnormal mammogram or Pap test.

17 Mental health, frequency of VA outpatient visits, and colorectal screening Medical records of 890 randomly selected VA patients Looked at diagnoses of mental illness and frequency of outpatient (OP) visits 580 (65%) had one or more MI diagnosis. Research Q: Were they adhering to recommendations for colorectal screening? The rate of screening adherence was 57% for those with 1 or more MI diagnoses compared to 47% for those with none. However, after adjusting for OP visit frequency (a strong predictor of screening, (AOR ), vets with MI (except for PTSD) were 62% as likely to have recommended CRC screening. Kodl (2010)

18 TREATMENT: Barriers and complications Comorbid conditions such as cardiovascular or respiratory diseases, obesity or malnourishment may limit treatment options. Interactions among psychotropic meds and drugs used in treatment for cancer may be problematic. Patients may have problems associated with radiation treatment. Overall, there is a lack of research related to adherence to treatment plans for cancer among individuals with SMI/SUD. Howard (2010)

19 Disparities in oral cancer survival Among oral cancer patients (n=16,687) from in Taiwan, 206 (1.2%) had a diagnosis of a mental illness. Patients with mental illness were: Half as likely to receive surgery (OR=0.47, 95% CI, ; p<0.001) More than 50% more likely to die within 5 years of diagnosis (adjusted for treatment modality) (HR=1.58, 95% CI, ; p<0.001) Chang et al. (2013)

20 Relative Risk for mortality among Western Australian cancer patients with psychiatric disorders Alcohol/drug Schizophrenia PD Depression MALE FEMALE Adapted from Kisely et al. (2013)

21 Five top cancer causes of death among people with mental illness in Ohio Musuuza et al. (2013)

22 SUMMARY: To reduce incidence and mortality of cancer among individuals with SMI/SUD Prevention Promote tobacco use prevention and cessation support. Poll 3 Provide effective SUD treatment. Promote physical activity and good nutrition. Screening Support the primary care relationship. Provide care coordination. Diagnosis Provide or facilitate access to patient-centered decision-making support. Treatment Provide or facilitate access to care coordination and navigation support. Continue mental health/sud treatment integrated with oncological care. Survivorship Promote tailored f/u prevention, care coordination and timely screening.

23 Decisional capacity assessment Assessment should be related to specific questions during treatment, rather than a general consent for treatment. Involve familiar members of behavioral treatment team to assist with explaining options and assessing patient s preferences.

24 Cost of care for breast cancer survivors with and without depression Jeffery (2014)

25 How can you obtain payment for providing these critical services? Stanek, Michael (2014). Promoting physical and behavioral health integration: Considerations for aligning federal and state policy. State Health Policy Briefing, a publication of the National Academy for State Health Policy. Stanek, Michael et al. (2014). Realizing rural care coordination. State Health and Value Strategies,, a publication of the National Academy for State Health Policy.

26 We need to know more. We need- More involvement of consumers and behavioral health providers in cancer prevention and treatment advocacy; More behavioral clinician involvement in multi-disciplinary treatment teams; More research: Perspectives of persons with MI and SUD; More information about confounding variables.

27 SELECTED REFERENCES Aggarwal A, Pandurangi A, & Smith W. (2013). Disparities in breast and cervical cancer screening in women with mental illness. American Journal of Preventive Medicine, 44; Butow P, Harrison JD, Choy ET, et al. (2007) Health professional and consumer views on involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Cancer, 110; Chang T, Hou S, Su Y et al. (2013) Disparities in oral cancer survival among mentally ill patients. PlosOne 8; e Druss BG, Rosenheck RA, Desai MM, & Perlin JB. (2002). Quality of preventive medical care for patients with mental disorders. Medical Care, 40; Ehrlich C, Kendall E, Frey N et al. (2014). Improving the physical health of people with severe mental illness: Boundaries of care provision. International Journal of Mental Health Nursing, 23; Hodgson R, Wildgust HJ, & Bushe CJ. (2010). Review: Cancer 60.and schizophrenia: Is there a paradox? Journal of Pyschopharmacology, 24:51- Howard LM, Bailey EA, Davies et al. (2010) Cancer diagnosis in people with serious mental illness: Practical and ethical issues. Lancet Oncology, 11; Jeffery DD. (2014). Prevalence, health care utilization, and costs of concomitant depression among breast cancer survivors. Poster/oral roundtable presented at the American Society of Clinical Oncology San Antonio Breast Cancer Symposium, Dec. 9-13, Kronman AC, Freund KM, Heeren T, et al. (2011). Depression and anxiety diagnoses are not related with delayed resolution of abnormal mammograms and Pap tests among vulnerable women. Journal of General Internal Medicine, 27; McClave AK, McKnight-Eily LR, Davis SP, & Dube SR. (2010). Smoking characteristics of adults with selected lifetime mental illnesses: Results from the 2007 National Health Interview Survey. American Journal of Public Health, 100; Muirhead, L. (2014). Cancer risk factors among adults with serious mental illness. American Journal of Preventive Medicine, 46; S98-S103. Parks J, Svendson D, Singer P, & Foti ME, Eds. (2006) Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors; Available at publicationsmeddir.cfm SAMHSA (2014) National Survey on Drug Use and Health Report. Available at:

28 COMMENTS & QUESTIONS

29 Introduction to Resources offered by GW Cancer Institute Enhancing Implementation of Comprehensive Cancer Control Activities Center for the Advancement of Cancer Survivorship, Navigation and Policy (casnp) George Washington University (GW) Cancer Institute December 2014

30 GW Cancer Institute Founded in 2003 Vision: To set the standard for patient-centered care and achieve health equity. Mission: To ensure access to quality, patientcentered care across the cancer continuum through community engagement, patient and family empowerment, health care professional education, policy advocacy, and collaborative multi-disciplinary research.

31 CDC Cooperative Agreement Title: Enhancing Implementation of Comprehensive Cancer Control Activities Timeframe: 5-year cooperative agreement ( ) Purpose: Provide technical assistance (TA) and training opportunities to support National Comprehensive Cancer Control Program grantees and their partners

32 Get involved: Address cancer disparities! National Comprehensive Cancer Control Program Comprehensive Cancer Control is an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through efforts across the cancer continuum. CDC started in 1998, and now supports programs in: 50 states District of Columbia 7 tribal groups 7 U.S. Associated Pacific Islands/territories Look up your local NCCCP Program:

33 Comprehensive Cancer Control TA Landscape Many TA resources exist, but They are not always accessed They do not fill every gap They need to be better organized and promoted There is tremendous opportunity for collaboration and crosspromotion Across Comprehensive Cancer Control programs and coalitions National Partners (e.g. American Cancer Society, C-Change, NAACHO, LiveStrong Foundation) Area Health Education Centers (AHECs) Behavioral Health Professionals

34 Activities Strategies Status at Start of Project Year 02 Communication and coordination of TA efforts Professional education and training Tools and resources Support for cancer and chronic disease integration efforts Enhanced connections across stakeholders Technical Assistance Portal website Searchable resource repository e- Newsletter Twitter Webinars Free online courses Social media toolkits Resource guides Priority alignment tool Survivorship report Community roundtables with Area Health Education Centers Ask the Expert series Expert database Mentorship program One-on-one TA Coordinate NP website Activities Key Launched In Progress

35 Communication and coordination of TA efforts Technical Assistance Portal

36 Communication and coordination of TA efforts Searchable Resource Repository Submit your own resources and success stories Find cancerrelated resources! e.g. Screening and detection initiatives e.g. Providers Filtered Results 36

37 Communication and coordination of TA efforts Filter Resource Repository Search terms to try Option name Resource(s) on Mental illness and substance abuse Screening and detection initiatives Tobacco and smoking Target Population(s) Providers People with mental health conditions People with substance use disorder Still have questions? Watch our How to use this website video found in the About section Tips If you get too many results, try adding filters e.g. Screening and detection initiatives AND Providers If you get too few results, try removing filters e.g. Screening and detection initiatives only If you cannot find what you are looking for or have a more specific search, try using the Search by Title keyword search box 37

38 38

39 Communication and coordination of TA efforts TA Roundup E-Newsletter To subscribe: or go to Stay informed! 39

40 Tools and resources Social Media Toolkits Toolkits target specific awareness months Social Media GW Cancer Institute Twitter account Spread the word! Month October 2014 November 2014 January 2015 February 2015 March 2015 September 2015 Topic Breast Cancer Lung Cancer Cervical Cancer/HPV World Cancer Day Colorectal Cancer Prostate Cancer Explains social media basics and provides a mini-tutorial on media management Provides sample Facebook posts and Tweets to use

41 Professional education and training Web-based training and education Webinars Past topics Effects of the Affordable Care Act among Cancer Survivors National Partnership Support to Comprehensive Cancer Control Coalitions Cancer Program Partnerships with Area Health Education Centers Coming Up Cancer Plan Goal Drafting and Monitoring Online Trainings Coming Up Executive Training on Navigation and Survivorship Patient Navigation Planned Best Practices for Enhancing Communication Cancer Policy 101

42 Center for the Advancement of Cancer Survivorship, Navigation and Policy (casnp) Survivorship & Navigation Resources E-news casnp listserv Health Policy Initiatives Policy reports and white papers Education & Training Research us at Visit us at Center for the Advancement of Cancer Survivorship, Navigation and Policy

43 How can I help my patients navigate cancer Contact the cancer center treatment? Contact the insurance company Contact your local chapter of Academy of Oncology Nurse & Patient Navigators (aonnonline.org) Contact a non-profit resource CancerCare ( , cancercare.org) American Cancer Society ( , cancer.org) Local community organizations 43

44 Cancer Survivorship E-Learning Series for Primary Care Providers Learn how to care for cancer survivors! CancerSurvivorshipCenterEducation.org Center for the Advancement of Cancer Survivorship, Navigation and Policy

45 Module 1 E-Learning Series: Module Topics The Current State of Survivorship Care and the Role of Primary Care Providers Module 2 Module 3 Late Effects of Cancer and its Treatments: Managing Comorbidities and Coordinating with Specialty Providers Late Effects of Cancer and its Treatment: Meeting the Psychosocial Health Care Needs of Survivors Center for the Advancement of Cancer Survivorship, Navigation and Policy

46 E-Learning Series: Module Topics Module 4 Module 5 Module 6 Modules 7-9 The Importance of Prevention in Cancer Survivorship: Empowering Survivors to Live Well A Team Approach: Survivorship Care Coordination Cancer Recovery and Rehabilitation Spotlight on Prostate/Breast/Colorectal Cancer Survivorship: Clinical Care Follow-Up Guidelines for Primary Care Providers Center for the Advancement of Cancer Survivorship, Navigation and Policy

47 GW Cancer Institute Resources Visit our Comprehensive Cancer Control technical assistance website and sign up for our monthly TA e-newsletter at: Visit us at to view previous webinars and reports Check out our FREE CME e-learning series at Follow us on us at (general cancer inquiries) or (navigation/survivorship inquiries) Center for the Advancement of Cancer Survivorship, Navigation and Policy

48 Additional Survivorship Resources National Cancer Survivorship Resource Center cancer.org/survivorshipcenter LIVESTRONG livestrong.org American Cancer Society s Cancer Survivors Network csn.cancer.org Cancer Care cancercare.org Patient Advocate Foundation patientadvocate.org Cancer and Careers cancerandcareers.org Cancer Legal Resource Center disabilityrightslegalcenter.org/cancer-legal-resource-center Center for the Advancement of Cancer Survivorship, Navigation and Policy

49 Mandi Pratt-Chapman Website: THANK YOU!

50 Cancer Prevention Approaches for People with Mental Illnesses and Addictions Question and Answer Session: Questions may be submitted by typing your question into the dialogue box to the right of your screen and sending it to the organizer. We ll answer as many of your questions as time allows!

51 Jointly funded by CDC s Office on Smoking & Health & Division of Cancer Prevention & Control Provides resources and tools to help organizations reduce tobacco use and cancer among people with mental illness and addictions 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Visit and Join Today! Free Access to Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions #BHtheChange

52 Thank you for joining us for the Cancer Prevention Approaches for People with Mental Illnesses and Addictions Webinar!