Serious mental illness and cancer - A call to action for equitable care

Sep 22, 2026

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Cancer advances are not distributed equitably across population segments. Individuals with serious mental illness (SMI) face compounded disparities in cancer detection, treatment, and survival. SMI, including schizophrenia, bipolar disorder, and severe major depression, is linked to major functional impairment and a 2–3 decade reduction in life expectancy. Patients encounter fragmented care, reduced access to therapeutics, limited psychosocial support, stigma, diagnostic overshadowing, and underrepresentation in trials.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

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Abstract

Introduction

Defining the issue

DOI: 10. 3322/caac.70095 REVIEW ARTICLE Serious mental illness and cancer: A call to action for equitable care Daniel McFarland DO, MS1,2 | Cristiane Bergerot PhD3 | Pernille Bidstrup PhD4 | Miri Cohen PhD5 | Paul D’Alton PhD6 | Shahrzhad Zamani DO7 | Louise Mullen MSc8 | Michelle Riba MD, MS9 | Luigi Grassi MD 10 | Kelly Irwin MD, MPH 11 1Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA 2Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA 3Oncoclinicas and Co-Medica Scientia Innovation Research (MEDSIR), Sao Paulo, Brazil 4Danish Cancer Institute, Copenhagen, Denmark 5School of Social Work, University of Haifa, Haifa, Israel 6School of Psychology, University College Dublin, Dublin, Ireland 7Florida State University, Tallahassee, Florida, USA 8National Cancer Control Program, Dublin, Ireland 9Department of Psychiatry, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA 10Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy 11Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA Correspondence Daniel McFarland, Department of Psychiatry, University of Rochester Medical Center, 600 Crittenden Boulevard, Rochester, NY 14610, USA. Email: [danielcurtismcfarland@gmail.com](danielcurtismcfarland@gmail.com) Abstract Cancer advances are not distributed equitably among many segments of the population. Specifically, individuals with serious mental illness (SMI) face compounded disparities in cancer detection, treatment, and survival. SMI, characterized by conditions such as schizophrenia, bipolar disorder, and severe major depression, is associated with significant functional impairment and a two-to-three-decade reduction in life expectancy. Patients with SMI encounter unique challenges when navigating cancer care, including fragmented care pathways, less access to cancer therapeutics, limited psychosocial support, stigma, heightened vulnerability to diagnostic overshadowing where symptoms are attributed to their psychiatric rather than a medical or oncologic condition, and underrepresentation in therapeutic clinical trials. This review explores the intersection of SMI and cancer care starting with the conceptual background and its importance related to cancer outcomes and the delivery of ethical care to highlight unmet needs and a multitude of barriers. The paper proposes practical recommendations to improve cancer care for individuals with SMI who develop cancer including adopting the collaborative care model, enhancing psychosocial and psychiatric integration in oncology settings, and addressing biases inherent in clinician training. Interventions targeting individual, interpersonal, health system, and policy levels are essential to comprehensively mitigating disparities and developing durable cancer delivery strategies. Equitable cancer care for patients with SMI is both a moral imperative and a cornerstone of advancing social justice in oncology. Thus, there is a critical need to prioritize the translation of research advances, to close the gap in cancer outcomesand mortality, and to improve patient outcomes and wellbeing. KEYWORDS behavioral oncology, health disparities, psychiatry, psychological oncology This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society. CA Cancer J Clin. 2026;e70095. [https://doi.org/10.3322/caac.70095](https://doi.org/10.3322/caac.70095) wi[leyonlinelibrary.com/journal/caac](leyonlinelibrary.com/journal/caac) 1 of 14 INTRODUCTION Def

FAQs

What disparities do patients with serious mental illness face in cancer care?

They experience worse cancer detection timing, reduced access to standard-of-care treatments, and poorer survival outcomes compared with patients without serious mental illness.

Why is serious mental illness associated with reduced life expectancy?

Serious mental illness is characterized by diagnosis with significant functional disability and long-term duration, leading to chronic impairment and difficulties coping with stressors.

What barriers contribute to inequitable cancer care for people with SMI?

Stigma, fragmented care pathways, limited psychosocial and medical support, diagnostic overshadowing, and underrepresentation in therapeutic clinical trials hinder engagement and navigation of care.

Sep 22, 2026

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