Cancer care for the homeless population: a literature review

Abstract

Abstract Background The last global survey in 2005 of the United Nations estimated that 100 million people were homeless. Cancer is becoming one of the most important public health problems worldwide, but specifically, the prevalence of cancer-related mortality for the homeless population has been reported to be double compared to the average adult population. To date, health research pays insufficient attention to studying cancer and improving the delivery of cancer care for the homeless population. Methods A systematic literature review of relevant databases was employed to identify all the quantitative studies addressing cancer care for the homeless population in English, Spanish, French and Portuguese. A total of 11,740 publications were identified. Results A total of 17 studies were included in this literature review. The majority of the studies were based on the United States (n = 13; 76.5%). Nearly half of the studies targeted the general homeless population (n = 9; 52.9%), and most studies specifically targeted homeless women (n = 6; 35.3%). The majority of studies examined specific types of cancer (n = 13; 76,5%). By type of cancer explored, breast cancer (n = 4; 23.5%) and cervical cancer (n = 4; 23.5%) were the most researched. Screening is the most prevalent topic investigated (n = 14; 82.4%). Studies report unequal access and utilization of cancer screening services as well as advanced stages of cancer when diagnosed. Additionally, longer delays to treatment have been reported. On the other hand, community-based screening strategies have proven to be effective in increasing screening rates. Conclusions Currently, American researchers appear to be leading exponents of cancer research on the homeless population and most of the research is focused on cancer screening. In this regard, community-based screening strategies have proven to be effective in reducing health inequalities for this vulnerable group but less is known when a positive case is diagnosed for this population. Key messages Cancer is a major disease burden worldwide and evidence shows higher mortality rates among the homeless population but unequal access and utilization of cancer screening and treatment services. Community cancer screening programmes for the homeless population should be internationally adopted and specific cancer care pathways meeting their needs after cancer diagnose should be provided.