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The Lesser Discussed Killer: Cancer

Rebecca Selove, PhD, MPH

Research Associate Professor, Center for Prevention Research, College of Agriculture, Human and Natural Sciences

Tennessee State University

Over the past decade, the mental health and addiction treatment field has established improved care collaboration efforts with general healthcare to meet the needs of people with behavioral health disorders who also have high prevalence rates of chronic health disorders — namely diabetes, heart disease, and obesity. The lesser-discussed killer? Cancer.

New research shows that individuals with serious mental illnesses have poorer outcomes following a diagnosis of cancer. This suggests that we need to provide integrated care once cancer has been diagnosed that accounts for a person’s mental health and substance abuse history in an evidence-informed way.

Unfortunately, individuals with behavioral health disorders are often reluctant to discuss their behavioral health issues with their primary care providers and other medical specialists. They see the medical field as compartmentalized — their interactions with the behavioral health world are separate from their general healthcare world. This can undermine the effectiveness of care for those who need treatment for cancer.

As a clinical psychologist who provided interventions for children diagnosed with cancer and their families, and adults transitioning off treatment for cancer, I developed a passion for the intersection of behavioral health research and cancer, and the health implications for a population that already experiences grave disparities in healthcare.

The National Council’s new National Behavioral Health Network for Tobacco & Cancer Control is uniquely positioned to address these disparities. We need to ensure that evidence-informed preventive care is designed to meet the unique needs of people with mental illnesses and addictions and that is compatible with the systems in which that care is provided.

Thankfully, a cadre of experts across the country has taken this to heart.

I spent a week this month as one of 14 fellows in the inaugural Mentored Training in Dissemination and Implementation (D&I) Research in Cancer at Washington University in St. Louis, funded by the National Cancer Institute. This training provides us with opportunities to engage in peer-to-peer collaborations and participate in a mentoring program to support and promote research efforts on cancer prevention and control disparities. I am delighted to have Dr. Enola Proctor as my mentor. With a background in social work and public health, she is Director of the Center for Mental Health Services Research at Washington University, and leads the NIMH-funded Implementation Research Institute (IRI), which trains researchers from across the nation in implementation science for mental health. D&I research offers a framework for progress in these complex endeavors.

D&I research focuses on disseminating information about evidence-informed practices, and implementing them in ways that address provider system capacity and reflect the culture and preferences of participants. The need for improving D&I is reflected in the infamous 17-year gap between research and practice that ultimately benefits only a small percentage of patients, along with persistent disparities in health among minorities and people with a history of serious mental illness. A recent example of D&I research, referred to as “knowledge translation” in some parts of the world, is an investigation of barriers to implementing smoking cessation programs in community mental health centers. Although there has been tremendous progress in this relatively new field, improving cancer care outcomes for individuals with mental illnesses, as with other public health aims, requires “a strong evidence base, political will to allocate resources to achieve the goal of implementation, and a social strategy that defines a plan of action to achieve the health goals” (p. 11).

The National Behavioral Health Network, with support from the CDC’s Division of Cancer Prevention and Control, has made a commitment to bring to light the disparity within the behavioral health population. Through webinars, tool kits, peer-to-peer dialogues, and more, the National Network aims to promote effective collaborations to enhance integration across systems of care to better serve individuals with behavioral health conditions. Learn more on our website.

 

Dr. Rebecca Selove, PhD, MPH currently serves as a Research Associate Professor at Tennessee State University, and as Behavioral Researcher for the U54-funded Meharry-Vanderbilt-TSU Cancer Partnership. Her current projects include evaluating the impact of serious mental illness on timeliness of biopsy and treatment among women 66 years and older following mammography; surveying parents of middle school students to engage them in efforts to prevent tobacco use; and developing implementation plans at two medical centers where feasibility of a navigated survivorship transition is being studied. She has continued her clinical work with a part-time private practice.