2021 CANCER & MENTAL WELLBEING EDUCATION TRAINING SERIES
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2021 CANCER & MENTAL WELLBEING
EDUCATION TRAINING SERIES:
A Call to Action – Ending Cancer Inequities
Using an Intersectional Framework
Wednesday, August 25, 2021
1:00 – 3:30 pm ET
Closed captioning:
https://www.streamtext.net/player?event=CancerEducationSeriesDay2
Welcome!
Tamanna Patel, MPH Samara Tahmid Hope Rothenberg
Director, Project Manager, Project Coordinator,
Practice Improvement Practice Improvement Practice Improvement
Housekeeping
• This workshop is being recorded. All participants
placed in “listen-only” mode.
• For audio access, participants can either dial into the
conference line or listen through your computer
speakers.
• Submit questions by typing them into the chat box or
using the Q&A panel.
• Access to closed captioning:
• https://www.streamtext.net/player?event=
CancerEducationSeriesDay2
• Slide handouts and recording will be posted here:
• https://www.bhthechange.org/resources/r
esource-type/archived-webinars/
National Behavioral Health Network for
Tobacco & Cancer Control
• Jointly funded by CDC’s Office on Smoking Visit www.BHtheChange.org and
& Health & Division of Cancer Prevention Join Today!
& Control
Free Access to…
• Provides resources and tools to help Toolkits, training opportunities, virtual
organizations reduce tobacco use and communities and other resources
cancer among individuals experiencing
mental health and substance use Webinars & Presentations
challenged State Strategy Sessions
Communities of Practice
• 1 of 8 CDC National Networks to eliminate
cancer and tobacco disparities in priority
populations
#BHthechange
Networking2Save: A National Network Approach to Promoting Tobacco and Cancer-Related Health Equity in Special Populations A consortium of eight national networks sponsored by the CDC’s Office on Smoking and Health and Division of Cancer Prevention and Control. Our partnership provides leadership on and promotion of evidence-based approaches for preventing commercial tobacco use and cancer for priority populations on a national, state, tribal and territorial level. https://www.cdc.gov/cancer/ncccp/related- programs/Networking2Save.htm
Session 1: Race to Comprehensive
Today’s Cancer Care for All - Panel
Featured Discussion
Sessions &
speakers
Hannah Bartol Michelle Jeu, MPH Marcela Gaitán, MPH., MA
Program Manager, ASPIRE Program Coordinator, Senior Director for External Relations
National Native Network Asian Pacific Partners for The National Alliance for Hispanic
Empowerment, Advocacy, and Health
Leadership (APPEAL)
Session 2: Engaging and Supporting
Today’s Low-income Communities - Cancer
Featured and Mental Health
Sessions &
speakers
Dwana “Dee” Calhoun
National Network Director,
SelfMade Health Network
Determinants of Health
Access to
Care 10%
Social &
Clinical Care
Economic
10%
Factors 40%
Health Physical
Traditional Health
Behaviors Environment
Programming
30-36%*
Outcomes 10%
*Source: https://www.goinvo.com/vision/determinants-of-health/
Cancer and Behavioral Health: What Has Caused the Disparity?
Behavioral and lifestyle factors
(smoking, alcohol use, nutrition access/diet)
Socio-environmental circumstances
Access to and quality of medical care
Bio-chemical factors
(co-morbidities, drug interactions, genetics)
Contextual inequities
(food environments, poverty, discrimination and more)
9
Cancer and Behavioral Health
•1 in 4 adults have some form of mental health or substance
use condition
•Mental health issues affect patients in all stages of cancer,
whether a pre-existing condition, during treatment, while in
remission, and often throughout the life course.
•While the evidence is still limited some research shows
that:
• Up to 50% of patients with terminal cancer have
been diagnosed with at least one psychiatric
disorder.
• Individuals with a mental illness may develop cancer
at 2.6 times a higher rate on account of late-stage
diagnosis and inadequate treatment and screenings.
Source: McGinty EE, Zhang Y, Guallar E, et al. Cancer incidence in a sample of
Maryland residents with serious mental illness. Psychiatr Serv. 2012; 63:714–717.
[PubMed: 22752037]Cancer and Behavioral Health
• Overall, the total cancer incidence was 2.6 times higher among adults
with serious mental illness vs adults without serious mental illness.
• Both schizophrenia and bipolar disorder are associated with a
significantly increased risk for cancer.
• The risk for lung cancer is 4 times higher among adults with serious
mental illness, and the risk for colorectal cancer was similarly elevated.
• The risk for breast cancer is elevated among women with schizophrenia
and bipolar disorder.
• In the studies conducted to date (very limited research) patients' race did
not statistically affect the higher risk for cancer associated with serious
mental illness.
Source: McGinty, E. E., Zhang, Y., Guallar, E., Ford, D. E., Steinwachs, D., Dixon, L. B., Keating, N. L., & Daumit, G.
L. (2012). Cancer incidence in a sample of Maryland residents with serious mental illness. Psychiatric services
(Washington, D.C.), 63(7), 714–717. https://doi.org/10.1176/appi.ps.201100169Continuum of Cancer Care: Barriers for
Behavioral Health
Lack of
research/data
Co-morbidities
Community
and other
individual risk
Barriers & and systems
Challenges to level barriers
factors
Cancer Care for
BH Populations
Insurance and Prevention,
financial screening,
coverage treatment and
challenges access gapsBut we don’t know the whole story…
The evidence to date from studies regarding mental illness and cancer is varied, complex, and
sometimes conflicting. Reports regarding cancer incidence are particularly inconsistent, with
studies finding the risk of cancer among individuals with mental illness to be higher, lower, or
equivalent to that of the general population.
Cancer is the second leading cause of death among individuals who experience mental health and
substance use disorders.
Source: Kisely S, Crowe E, Lawrence D. Cancer-Related Mortality in People With Mental
Illness. JAMA Psychiatry. 2013;70(2):209–217. doi:10.1001/jamapsychiatry.2013.278
13Race to Comprehensive Cancer Care for All -
Panel Discussion
Hannah Bartol Michelle Jeu, MPH Marcela Gaitán, MPH., MA
Program Manager, ASPIRE Program Coordinator, Senior Director for External Relations
National Native Network Asian Pacific Partners for The National Alliance for Hispanic
Empowerment, Advocacy, and Health
Leadership (APPEAL)Cancer Education Series:
Engaging and Supporting Low-Income Communities:
Cancer and Mental Health
Presenter: Dwana “Dee” Calhoun, MS-National Network Director
SelfMade Health Network (SMHN)
August 25, 2021National Cancer Institute (NCI):
Cancer Disparities
Cancer disparities (sometimes known as cancer health disparities) are differences in
cancer measures such as:
incidence (new cases)
prevalence (all existing cases)
mortality (deaths)
survival (how long people survive after diagnosis)
morbidity (cancer-related health complications)
survivorship (including quality of life after cancer treatment)
financial burden of cancer or related health conditions
screening rates
stage at diagnosis
“Cancer disparities can also be seen when outcomes are improving overall but
improvements are not seen in some populations relative to other populations.”
Certain populations “bear a disproportionate burden of cancer” compared with other
populations.Social Determinants of Mental Disorders and
Sustainable Development Goals Model:
Low Socioeconomic Status (SES)
Reference: Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, Haushofer J, Herrman H, Jordans M, Kieling
C, Medina-Mora ME, Morgan E, Omigbodun O, Tol W, Patel V, Saxena S. Social determinants of mental disorders and the
Sustainable Development Goals: a systematic review of reviews. Lancet Psychiatry. 2018 Apr;5(4):357-369. doi:
10.1016/S2215-0366(18)30060-9. PMID: 29580610.Social Determinants of Health and Mental Disorders Reference: Compton, M. and Ruth S Shim. “Why Employers Must Focus on the Social Determinants of Mental Health ” American Journal of Health Promotion 34 (2020): 215 - 219.
Socioecological model:
Cancer Screening, Prevention and Treatment Among
Populations with Mental Disorders
Reference: Weinstein LC, Stefancic A, Cunningham AT, Hurley KE, Cabassa LJ, Wender RC. Cancer screening, prevention, and
treatment in people with mental illness. CA Cancer J Clin. 2016 Mar-Apr;66(2):134-51. doi: 10.3322/caac.21334. Epub 2015
Dec 10. PMID: 26663383; PMCID: PMC4783271.Across the Cancer Continuum:
Low Socioeconomic Status (SES) Factors
Reference: Whitney E. Zahnd, Sara L. McLafferty, Jan M. Eberth. Multilevel analysis in rural cancer control: A conceptual
framework and methodological implications, Preventive Medicine, Volume 129, Supplement, 2019, 105835, ISSN 0091-7435,
https://doi.org/10.1016/j.ypmed.2019.105835Cancer Prevention:
Behavioral Risk and Social Determinants of
Health (SDoH)
Reference: Accelerating the Pace of Cancer Prevention- Right Now. Graham A. Colditz and Karen M. Emmons
Cancer Prev Res April 1 2018 (11) (4) 171-184; DOI: 10.1158/1940-6207.CAPR-17-0282Depression and Anxiety Among Cancer Survivors Reference: Niedzwiedz, C.L., Knifton, L., Robb, K.A. et al. Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer 19, 943 (2019). https://doi.org/10.1186/s12885-019-6181-4
Cancer Survivorship:
Psychiatric conditions and Low Socioeconomic
Status (SES)
Some cancer patients and survivors
suffer from psychological problems,
such as depression. This may
interfere with the patient's ability to
cope with the multiple
responsibilities, demands or
Low Socioeconomic Status (SES) perceived “burden” of managing
their medical condition (cancer) or
comorbidities (including cancer).
Depression and anxiety affect up to
approximately 20% and 10% of
patients with cancer respectively,
regardless of the point in the cancer
trajectory, and whether in curative
References: or palliative treatment.
Krebber AM, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report
instruments. Psychooncology. 2014;23(2):121-130. doi:10.1002/pon.3409
Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ 2018; 361:k1415 doi:10.1136/bmj.k1415Nexus: COVID-19 Pandemic, Psychiatric
Conditions and Low Socioeconomic Status (SES)
There are multiple pathways by which persons with psychiatric conditions may
be at greater risk for COVID-19 hospitalization and mortality.
Social determinants of health (SDoH) may increase COVID-19 risk including:
Economic insecurity (loss of employment, loss of stable income, loss of
permanent housing, loss of healthcare insurance coverage, etc.)
Minimal or insufficient access to primary care and preventive healthcare
services (including cancer screenings and follow-up)
Lower health literacy
References: Ceban F, Nogo D, Carvalho IP, et al. Association Between Mood Disorders and Risk of COVID-19 Infection,
Hospitalization, and Death: A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online July 28, 2021.
doi:10.1001/jamapsychiatry.2021.1818COVID-19 Pandemic: Impact on Cancer Screening
Differences and overlap similarities for the pathogenesis, incidence, and mortality risks
between cancer and COVID-19
Reference: Lisa A. Newman et al. Similarities in Risk for COVID-19 and Cancer Disparities Clin Cancer Res 2021;27:24-27COVID-19 and Future Cancer Outcomes Reference: American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021.
Colorectal Cancer Example:
Low Socioeconomic Status (SES) Factors,
Mental Health and Comorbidities
Reference: Mahar AL, Kurdyak P, Hanna TP, Coburn NG, Groome PA (2020) The effect of a severe psychiatric illness on
colorectal cancer treatment and survival: A population-based retrospective cohort study. PLoS ONE 15(7): e0235409.
https://doi.org/10.1371/journal.pone.0235409Collaborative Models of Care (1) Reference: Mandelblatt, J.S., Yabroff, K.R. and Kerner, J.F. (1999), Equitable access to cancer services. Cancer, 86: 2378- 2390. https://doi.org/10.1002/(SICI)1097-0142(19991201)86:113.0.CO;2-L
Psychiatric Conditions and Cancer (1) Psychiatric conditions or disorders have been shown to affect approximately 30-35% of cancer patients during phases of the disease trajectory, and differ in nature according the stage and type of cancer. Potential barriers associated with minimal adherence to recommended cancer treatment are compounded by depression or other symptoms of psychiatric disorders or conditions. Patients diagnosed with mental illness or psychiatric conditions may possess difficulty recognizing, communication and/or self- managing cancer treatment related complications; this may contribute to unfavorable health outcomes or exacerbate cancer disparities. Mortality rates in populations diagnosed with mental disorders are much greater compared to general population and attributed to chronic medical conditions including cardiovascular disease and cancer. Contributing factors include: Delayed cancer diagnosis Lack of access to cancer screening resulting in advanced staging at diagnosis Reduced access to or utilization of appropriate cancer treatments following diagnosis References: Caruso R, Breitbart W. Mental health care in oncology. Contemporary perspective on the psychosocial burden of cancer and evidence-based interventions. Epidemiol Psychiatr Sci. 2020;29:e86. Published 2020 Jan 9. doi:10.1017/S2045796019000866 Kisely S, Crowe E, Lawrence D. Cancer-Related Mortality in People With Mental Illness. JAMA Psychiatry. 2013;70(2):209–217. doi:10.1001/jamapsychiatry.2013.278 Koroukian SM, Sajatovic M. Increased cancer-specific mortality in individuals developing mental disorders after cancer diagnosis: biomedical factors versus psychosocial support. Ann Transl Med. 2017;5(21):432. doi:10.21037/atm.2017.08.37
Psychiatric Conditions and Cancer (2):
Periods of Increased Vulnerability
Periods of Increased Vulnerability for Distress Among Patients Diagnosed With Cancer
Finding a suspicious symptom or abnormal lab test result
During diagnostic workup
Finding out the diagnosis
Awaiting treatment
Change in treatment modality
End of treatment
Discharge from hospital following treatment
Transition to survivorship
Medical follow-up and surveillance
Cancer treatment failure
Recurrence/progression
Advanced cancer
End of life
Reference: Pirl WF, Fann JR, Greer JA, Braun I, Deshields T, Fulcher C, Harvey E, Holland J, Kennedy V, Lazenby M, Wagner L, Underhill M, Walker DK,
Zabora J, Zebrack B, Bardwell WA. Recommendations for the implementation of distress screening programs in cancer centers: report from the American
Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force. Cancer. 2014 Oct
1;120(19):2946-54. doi: 10.1002/cncr.28750. Epub 2014 May 2. PMID: 24798107.Equitable Cancer Care:
Collaborative Care Models
Collaborative care models have been shown to be more effective than usual care for depression,
anxiety, bipolar disorder, and schizophrenia among cancer survivors.
Distress clearly occurs at a significant level in at least 1/3 of cancer patients, with frequency and
severity increasing with advanced stages of illness.
Distress should be recognized, monitored, documented, and treated promptly at all stages of
disease. All patients should be screened for distress during the initial visit, during appropriate
and routine intervals, and as clinically indicated, especially with changes in disease status such as
remission, recurrence, disease progression.
References:
Morreale MK, Balon R, Beresin EV, Coverdale JH, Brenner A, Guerrero A, Louie AK, Roberts LW. Providing Psychiatric Care for an
Expanding Population of Cancer Survivors: Imperatives for Psychiatric Education and Leadership. Acad Psychiatry. 2017
Feb;41(1):1-3. doi: 10.1007/s40596-016-0650-8. Epub 2016 Dec 5. PMID: 27921265.
Holland JC, Bultz BD; National comprehensive Cancer Network (NCCN). The NCCN guideline for distress management: a case for
making distress the sixth vital sign. J Natl Compr Canc Netw. 2007 Jan;5(1):3-7. PMID: 17323529.Collaborative Care Models (2)
Reducing Cancer Disparities Among Populations with Low Socioeconomic Status Characteristics: Homeless Population Example
Equitable Cancer Care: Resources and
Evidence-based Interventions(1)
American Society of Clinical Oncology (ASCO) Cancer Treatment and Survivorship Care Plans
https://www.cancer.net/survivorship/follow-care-after-cancer-treatment/asco-cancer-treatment-and-survivorship-care-
plans
Implementing the Commission on Cancer Standard 8.1: Addressing Barriers to Care (George Washington University Cancer
Center)
https://smhs.gwu.edu/cancercontroltap/resources/implementing-commission-cancer-standard-81-addressing-barriers-care
National Cancer Institute (NCI)- Repository of resources featuring guidelines cancer survivorship guidelines
https://cancercontrol.cancer.gov/ocs/resources/health-care-professionals#guidelines
American Academy of Family Physicians (AAFP) –Social Determinants of Health (SDoH) Screening Guide and Tool
https://www.aafp.org/family-physician/patient-care/the-everyone-project/toolkit/assessment.html
Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE)
https://www.nachc.org/research-and-data/prapare/
National Health Care for the Homeless Council
https://nhchc.org/clinical-practice/Equitable Cancer Care: Resources and
Evidence-based Interventions (2)
Patel MI, Lopez AM, Blackstock W, Reeder-Hayes K, Moushey EA, Phillips J, Tap W. Cancer Disparities and Health Equity: A
Policy Statement From the American Society of Clinical Oncology. J Clin Oncol. 2020 Oct 10;38(29):3439-3448. doi:
10.1200/JCO.20.00642. Epub 2020 Aug 12. Erratum in: J Clin Oncol. 2020 Nov 20;38(33):3976. PMID: 32783672; PMCID:
PMC7527158.
National Academies of Sciences, Engineering, and Medicine 2021. Advancing Progress in the Development and
Implementation of Effective, High-Quality Cancer Screening: Proceedings of a Workshop. Washington, DC: The National
Academies Press. https://doi.org/10.17226/26019
Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records; Board on
Population Health and Public Health Practice; Institute of Medicine. Capturing Social and Behavioral Domains and Measures
in Electronic Health Records: Phase 2. Washington (DC): National Academies Press (US); 2015 Jan 8. 4, Measures Reviewed
for Each Candidate Domain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK269339/
Hilary Daniel, Sue S. Bornstein, Gregory C. Kane. Addressing Social Determinants to Improve Patient Care and Promote
Health Equity: An American College of Physicians Position Paper. Ann Intern Med.2018;168:577-578. [Epub ahead of print
17 April 2018]. doi:10.7326/M17-2441
Roick J, Danker H, Kersting A, Dietrich A, Dietz A, Papsdorf K, Meixensberger J, Stolzenburg JU, Wirtz H, Singer S. Predictors
of psychiatric comorbidity in cancer patients at the time of their discharge from the hospital. Soc Psychiatry Psychiatr
Epidemiol. 2021 Jul 25. doi: 10.1007/s00127-021-02138-1. Epub ahead of print. PMID: 34304277.
Williams A, Erb-Downward J, Bruzelius E, et al. Exploring cancer screening in the context of unmet mental health needs: a
participatory pilot study. Prog Community Health Partnersh. 2013;7(2):123-134.Equitable Cancer Care: Resources and
Evidence-based Interventions (3)
National Colorectal Cancer Roundtable (NCCRT)
https://nccrt.org/resource-center/
Rivera, M. & Katki, Hormuzd & Tanner, Nichole & Triplette, Matthew & Sakoda, Lori & Wiener, Renda & Cardarelli, Roberto
& Carter-Harris, Lisa & Crothers, Kristina & Fathi, Joelle & Ford, Marvella & Smith, Robert & Winn, Robert & Wisnivesky,
Juan & Henderson, Louise & Aldrich, Melinda. (2020). Addressing Disparities in Lung Cancer Screening Eligibility and
Healthcare Access. An Official American Thoracic Society Statement. American Journal of Respiratory and Critical Care
Medicine. 202. e95-e112. 10.1164/rccm.202008-3053ST.
Accessed at: https://www.atsjournals.org/doi/full/10.1164/rccm.202008-3053ST
National Academies of Sciences, Engineering, and Medicine. 2019. Investing in interventions that address non-medical,
health-related social needs: Proceedings of a workshop. Washington, DC: The National Academies
Press. https://doi.org/10.17226/25544Dwana “Dee” Calhoun, MS National Network Director E-mail address: d.calhoun@selfmadehealth.org Social Media: Twitter: @SelfMade Health Twitter: @DeeCalhounSMHN *Facebook: SelfMade Health Network Website: http://www.selfmadehealth.org/ Membership Information: Sign-up to become a national network member Quarterly Newsletter: Available to member organizations and state programs Send questions or contact us at anytime via shared SMHN mailbox: info@selfmadehealth.org
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