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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 159-160

Mental health care as part of cancer care: A call for action, advocacy, and activism



Date of Submission16-Jan-2020
Date of Acceptance17-Jan-2020
Date of Web Publication24-Feb-2020

Correspondence Address:
Rajani Surendar Bhat
92, Supreme Enclave, Mayur Vihar Phase 1, Delhi - 110 091

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_29_20

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How to cite this article:
Bhat RS, Dighe MD. Mental health care as part of cancer care: A call for action, advocacy, and activism. Cancer Res Stat Treat 2020;3:159-60

How to cite this URL:
Bhat RS, Dighe MD. Mental health care as part of cancer care: A call for action, advocacy, and activism. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Aug 3];3:159-60. Available from: http://www.crstonline.com/text.asp?2020/3/1/159/279106



Jagan et al. raise a matter of great concern with their call to action for addressing mental health as a part of cancer care.[1] We believe, as the authors do, that the current reported average of 750 cancer-related suicides per year is unreliable and likely vastly underestimated. They have mentioned the factors of underreporting and bias. It is likely that some patients' deliberate discontinuation of treatment, while not reported as suicide, could also be a form of self-harm arising from mental health problems in this vulnerable group.

While the issue of mental health needs to be addressed in the larger context of the deficit in palliative care services accessible to all cancer patients, it would be equally important to address the role of social determinants of mental health. Cancer care places a tremendous financial burden on patients, caregivers, and entire families. Often, in addition to the disease factors contributing to severe depression, social, cultural, and financial issues play a role in the deterioration of mental health. The WHO document on social determinants of mental health outlines the vulnerabilities that predispose certain groups to mental health issues.[2] These determinants hold true across cultures and geography. Low socioeconomic conditions, gender, myriad environmental factors at play from prenatal to early childhood to family and work dynamics, and intergenerational transfer of disadvantage contribute to the increasing likelihood of mental illness. The studies quoted from Sweden and the US show us that other healthcare delivery systems suffer from the same malady of increased risk of suicide among cancer patients. While Sweden has a national comprehensive healthcare program, the US largely runs on private health insurance and the financial burden of cancer care can incapacitate or bankrupt families. Newer sociological studies show that raising the minimum wage helps to lower the overall rate of suicide, which by extension could impact cancer-related suicide as well.[3] We must address the role of social determinants of mental health specifically in the cancer population, to avoid the risk of medicalizing a more complex public health issue and pharmacologizing the solution when larger public health and social reform are essential.

The authors rightly acknowledge the importance of patients' emotional, psychological, and cognitive needs to be addressed throughout treatment, survivorship, and palliation. They propose a multipronged approach to tackle this with measurement of the problem, building support groups, increasing awareness of treatment options in the public to tackle the nihilist perception of cancer care, and increasing trained mental health personnel to support oncologists. Investment in producing more trained mental health professionals will require greater inputs by the government in higher education. In fact, all essential measures proposed require considerable interest and investment from government and professional bodies. We thank the authors for raising a matter of concern and a cause toward which we may direct our energy as patient advocates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jagan SM, Abraham J, Mathew A. Mental health care as part of cancer care: A call for action. Cancer Res Stat Treat 2019;2:244-5.  Back to cited text no. 1
  [Full text]  
2.
Social Determinants of Mental Health. WHO and the Calouste Gulbenkian Foundation; 2014. Available from: https://www.who.int/mental_health/publications/gulbenkian_paper_social_determinants_of_mental_health/en/. [Last accessed on 2020 Jan 15].  Back to cited text no. 2
    
3.
Kaufman JA, SalasHernández LK, Komro KA, Livingston MD. Effects of increased minimum wages by unemployment rate on suicide in the USA. J Epidemiol Community Health 2020;pii: jech-2019-212981. doi: 10.1136/jech-2019-212981. [Epub ahead of print].  Back to cited text no. 3
    




 

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