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• Mental health problems and cancer: kills two birds with one stone
  Alain Braillon
  Published on: 15 January 2020

• Published on: 15 January 2020

  Mental health problems and cancer: kills two birds with one stone

  • Alain Braillon, Senior consultant, University Hospital, Amiens, France

  Davis and colleagues must be commended for their concern about cancer outcomes in patients with mental disorders and for acknowledging the poor quality of research.(1) However, their statement “pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis “ deserve comment.

  Firstly, patients with mental disorders, as all vulnerable populations, have poor access to care, considering either quantitatively or qualitatively, even more for specialized care, whatever it could be. Accordingly, a vertical approach only targeting patients with mental disorders would only be a partial and symptomatic solution A root cause analysis is a prerequisite to expect fixing a systemic failure.

  Secondly, the term “pre-existing mental disorder” must be questioned as tobacco and alcohol cause both mental health problems and cancer. There is robust and accumulating evidence that cigarette smoking is a causal risk factor for anxiety, depression and, even severe mental illness such as bipolar disorder.(2) Cessation is associated with reduced depression, anxiety and, improved quality of life. While one can understand most patients are fooled by the immediate effects of smoking on perceived stress (decreasing cerebral pain from nicotine withdrawal), the fact that too many psychiatric setting remain smokehouses question the quality of care.(3) Similarly, in many experience, as a second line specialist for severe alcohol use disorders, many of patients referred t...

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  Davis and colleagues must be commended for their concern about cancer outcomes in patients with mental disorders and for acknowledging the poor quality of research.(1) However, their statement “pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis “ deserve comment.

  Firstly, patients with mental disorders, as all vulnerable populations, have poor access to care, considering either quantitatively or qualitatively, even more for specialized care, whatever it could be. Accordingly, a vertical approach only targeting patients with mental disorders would only be a partial and symptomatic solution A root cause analysis is a prerequisite to expect fixing a systemic failure.

  Secondly, the term “pre-existing mental disorder” must be questioned as tobacco and alcohol cause both mental health problems and cancer. There is robust and accumulating evidence that cigarette smoking is a causal risk factor for anxiety, depression and, even severe mental illness such as bipolar disorder.(2) Cessation is associated with reduced depression, anxiety and, improved quality of life. While one can understand most patients are fooled by the immediate effects of smoking on perceived stress (decreasing cerebral pain from nicotine withdrawal), the fact that too many psychiatric setting remain smokehouses question the quality of care.(3) Similarly, in many experience, as a second line specialist for severe alcohol use disorders, many of patients referred to me are treated with antidepressants. Antidepressants have modest, if any, useful effects in depressed drinkers but have a potential to aggravate drinking outcomes (pathological intoxication with marked lost control and, occasionally serious violence, even suicide or homicide).(4) This is a real issue in France: a) the use of alcohol, a most depressive agent, is a public health crisis as in England; b) in contrast to England psychotherapy is not reimbursed by the French mandatory healthcare scheme yet despite the success of the Improving Access to Psychological Therapies programme launched in 2008.

  Last, even if a pre-existing mental disorder can to be the main concern, as in patients with schizophrenia, no one must overlook that these patients are 3.5 times more likely to die than the general population due to lung cancer, chronic obstructive pulmonary and cardiovascular diseases. For the main psychiatric cause of death, suicide, whose prevention remains a challenge, standardized mortality ratios is 52/100,000 person-years vs 75 for lung cancer.(5) In contrast, adequate treatment for smoking cessation, psychotherapy and nicotine replacement therapy with the belt and brace strategy (patches plus oral forms to suppress occasional craving, at increasing doses) is most effective, whether there are mental health disorders or not.

  1 Davis LE, Bogner E, Coburn NG et al. Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis. J Epidemiol Community Health 2020;74:84-94.

  2 Vermeulen JM, Wootton RE, Treur JL et al. Smoking and the risk for bipolar disorder: evidence from a bidirectional Mendelian randomisation study. Br J Psychiatry. 2019. Online Sep 17. doi: 10.1192/bjp.2019.202.

  3 Evins AE, Cather C, Daumit GL. Smoking cessation in people with serious mental illness. Lancet Psychiatry2019;6:563-564.

  4 Braillon A. Alcohol Use Disorders and the Barrel of the Danaids. Alcohol Alcohol 2016;51:774.

  5 Gatov E, Rosella L, Chiu M, et al. Trends in standardized mortality among individuals with schizophrenia, 1993–2012: a population-based, repeated cross-sectional study. CMAJ 2017;189:E1177–87.

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  Conflict of Interest:
  None declared.

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