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Cancer screening among homeless people

Cancer affects homeless and homeless people twice as often as the general population and is the second leading cause of death in this medically underserved group. At the same time, there is a lack of awareness and structure for targeted cancer care. Against this background, a team led by MedUni Vienna researched the current situation in four European countries and formulated approaches for the development of a prevention program. The study has just been published in the specialist journal eClinicalMedicine.

The study by the research team led by Tobias Schiffler and Igor Grabovac from the Department of Social and Preventive Medicine at MedUni Vienna's Center for Public Health surveyed the experiences and perspectives of those directly affected: homeless and homeless people with and without cancer, as well as professionals in health and social service institutions. Members of these groups in Austria, Greece, the United Kingdom and Spain provided insights into existing realities and barriers to cancer care for people on the margins of society. "The data on this issue has been extremely thin," says first author Tobias Schiffler, emphasizing the high relevance of the qualitative research.

Check-ups as a "luxury
As the study found, awareness of cancer screening among homeless and homeless people is low, both among those affected themselves and among representatives of health and social services. For example, one homeless person from Austria spoke in the interview of a "luxury to take care of preventive examinations and check-ups when you are still carrying around acute problems." There is also a shortage of target-group-specific cancer prevention services. Individual local initiatives usually fail to reach homeless and homeless people to a sufficient degree.

When cancer is discovered in a member of this underserved population, it is often in connection with emergency medical care for an acute illness or injury. Alternatively, the tumor may already be so advanced that it is causing symptoms. Regular treatment or follow-up care, which may then still be possible, naturally proves difficult due to the living conditions of homeless and homeless people. In some countries, those affected also face financial or structural barriers to accessing the health care system. As a result, homeless people are not able to take care of their health to the extent that they would actually like to - even according to their own statements. Accordingly, illnesses are often detected late or too late.

Life expectancy of 47 years
The average life expectancy of homeless people is 47 years, according to data from Great Britain. This is due to the overall higher burden of disease among this group. Cancer strikes people experiencing homelessness twice as often as the general population. This is associated with, among other things, a higher prevalence of risk behaviors (e.g., alcohol and tobacco use), but also a higher incidence of infectious diseases and malnutrition, as well as the aforementioned barriers to accessing health services.

Our study is one of the first to look at cancer prevention from the perspective of those directly affected. The results can form the basis of tailored and targeted prevention measures that take into account the needs and circumstances of this target group," says study leader Igor Grabovac. The study was conducted as part of the large-scale EU project "CANCERLESS" (Cancer prevention and early detection among the homeless population in Europe: Co-adapting and implementing the Health Navigator Model), also led by Grabovac.

Publication: eClinicalMedicine
Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study;
Tobias Schiffler, Christina Carmichael, Lee Smith, Ascensión Doñate-Martínez, Tamara Alhambra-Borrás, Miguel Rico Varadé , Jaime Barrio Cortes, Matina Kouvari, Pania Karnaki, Maria Moudatsou, Ioanna Tabaki, Alejandro Gil-Salmeron, Igor Grabovac;