Key takeaways
- People experiencing homelessness (PEH) have a higher cancer incidence and mortality rate compared to the housed population.
- PEH are often exposed to several cancer related risk factors?
- There are multiple barriers for accessing healthcare services for this population and services often struggle to meet their needs.?
- Understanding these barriers, building a rapport with individuals, and collaborating with community teams is essential.??
People experiencing homelessness (PEH) have higher cancer incidence and mortality rates compared to the housed population and the rates of PEH are rising.??
Homelessness is typically thought of as those who are rough sleeping but can also include groups such as those who are sofa surfing, seeking sanctuary, fleeing domestic violence, or returning to live in a relative’s home. The term ‘no fixed abode’ can be favourable as this also covers groups such as the travelling community who can experience similar barriers to PEH.
Potential pitfalls: Risk factors and barriers to accessing healthcare.
The average age of death for men and women experiencing homelessness is 45 and 43, respectively.?
The reason for the high cancer incidence and mortality rate in this population is a complex issue driven by multiple factors.?
- PEH can be more commonly exposed to cancer risk factors such as tobacco use, alcohol consumption, substance abuse, sexual behaviours associated with increased risk, environmental risk factors such as sun exposure or pollutants, and poor diets, for example obtaining food from food banks which typically provide high-calorie meals.?
- Poor physical health concerns, mental health issues, and the psychological effects of previous trauma may influence the health seeking behaviours of PEH.?
- Environmental factors may even contribute to a lack of awareness of cancer signs and symptoms in this population, for example, UV lights used in certain public toilets can mask the appearance of blood in the stool or sputum.?
- Receiving an invitation letter for a screening test or appointment is difficult for a patient without a fixed address.??
- Daily needs, such as food and shelter, and a lower cancer awareness may make PEH less likely to attend appointments or cancer screening programmes.??
- Shame, cultural taboos, and previous trauma can impact an individual’s willingness to take part in screening tests or investigations.?
- This population may avoid seeking help due to fear of discrimination or stigma associated with their social circumstances resulting in a cycle that contributes to health disparities.
- Transport can be a problem due to low income or vehicle access.???
- Rigid appointment times may not meet the needs of some patients, for example sex workers often work in the evenings and early mornings.
Helpful hints: Addressing barriers.
Record the housing status of patients to identify those at risk in your practice, consider a flag on your clinical system highlighting patients with no fixed abode.?
Patients of this population can change accommodation frequently; therefore, communication with services who may have been in contact with them is essential in their management.??
- Collaboration with teams such as support workers, drug and alcohol services, social prescribers, and social workers are helpful to locate, understand, and support this group of patients.?Building a rapport with patients is crucial to fostering engagement with services. Since patients may not always be willing to engage initially, establishing a positive therapeutic relationship and gaining an understanding of their background is essential.?
- Consider longer appointments, changes to appointment times to meet their lifestyle, and pre-booked follow-up appointments.
- Provide patient information of differing literacy level and languages to meet communication needs.?
- Clear documentation of the patient’s background on your clinical system or referral letters is helpful to aid clinicians to understand the situation, and that additional measures may need to be taken to follow-up or meet the needs of the patient.?
- Consider tracking patients who are high-risk in this population within your practice and review whether they have attended any planned investigations or appointments etc.
Outreach programmes, charities, and mobile health clinics play a vital role in addressing healthcare and screening accessibility barriers for PEH. These initiatives are often located in places commonly visited by PEH, such as shelters, soup kitchens, and community centres. Consider exploring the resources available in your community and signpost appropriately.
Practice takeaway
To hear more insights and practical advice you can listen to our GP’s Talk Cancer podcast episode ‘Cancer in the homeless population’, with guest Dr Wan-Ley Yeung a clinical lead of the GP Inclusion Health Service.?
Explore our cancer screening courses covering breast, bowel and cervical to gain essential guidance on improving uptake and reducing barriers to screening participation in the homeless population.?
