Addressing the unmet mental health needs of cancer patients in the England.
1.8million people are currently living with cancer in England. This is set to grow to 3million by 2030 (UK Department of Health, Macmillan Cancer Support & NHS Improvement, 2013). This can be largely attributed to an increased prevalence of unhealthy lifestyles. Advancements in treatment and early diagnosis means that 40% are not expected to die from the disease (Macmillan Cancer Support, 2013). 50% are expected to live beyond five years compared to only 28% in the early 1970s (Gordon-Dseagu, 2006).
Whilst many will return to their normal lives many will suffer the consequences of treatment or continue to live with cancer, further one in four will suffer two or more comorbidities. Cancer can now be considered a long-term disease (Macmillan Cancer Support, 2013).
Government issued a mandate to the NHS Commissioning Board in 2012 expecting progress in support for those surviving cancer to live a better quality (UK Department of Health, 2013). This is reflected in domain two of the NHS outcomes framework.
Public health concern:
The physical long-term consequences of treatment include chronic fatigue, sexual difficulties, moderate to severe pain, incontinence, gastrointestinal problems and lymphedema. People can also suffer psychological problems as a consequence of their cancer diagnosis and treatment. These can last for many years.
49% say they experience depression as a result of their cancer diagnosis (Cardy et al., 2006). Depression, anxiety and post-traumatic stress disorder (PTSD) are also common. It is estimated that 240,000 cancer patients have a mental health problem (Macmillan Cancer Support, 2013). Singer et al (2013) found that 30% of those with cancer were also diagnosed with a mental health condition and few received care early enough. Naylor et al (2012) suggests that identification of depression amongst people with a long-term condition largely goes undetected and untreated. Hobbie et al (2000) found that 20.5% of young adults that had been diagnosed with a childhood cancer suffered from PSTD at some point from the end of their treatment. Care received is unlikely to be relevant to the needs of the patient.
‘Chemo brain’ is a side effect of chemotherapy treatment. The American Cancer Society has identified a link between ‘chemo brain’ and depression. Radiation treatment has also been shown to cause depression (American Cancer Society, 2014).
“Depression and/or anxiety disorders may decrease adherence to medical treatment; increase unhealthy behaviour such as smoking, substance misuse, and poor diet; and lead to poorer outcomes for those suffering with chronic diseases.” Department of Health (2008, p. 3).
The link between cancer and mental health is not new however, Finlay et al (2011, cited in Naylor, 2012) suggests that a decrease in generalism and increases in specialisms and sub specialisms has led to an oversight in the multiple needs from multiple morbidities in patients. Care can be fragmented due to the split between specialist commissioning and local community care. There is a need for collaboration across disciplines.
Tacking mental health conditions will improve quality of life of those with cancer and improve survival rates (Spiegal, 2014).
Failing to meet this challenge will increased the use of health resources, reduced economic activity and increase dependency on benefits resulting in significant cost implications for NHS England and the wider economy. Whilst figures are not available for the impact of those with a cancer diagnosis, Naylor et al (2012) suggests that the burden of poor mental health linked to long-term conditions is a cost to the NHS of between £8billion and £13billion. Layard (2006) suggests that £9billion per year is lost in tax receipts...
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