Aim
Patients with serious mental illness (SMI) face significant cancer outcome disparities. While psychosocial interventions are well-documented, actionable pharmacological data remains inconsistently addressed. This review aimed to identify and define evidence-based pharmacological interventions to optimise the safety and efficacy of treatments for cancer and SMIs.
Method
A scoping review was undertaken using published literature between January 1998 and August 2026 describing pharmacological interventions for adults with SMI receiving cancer treatment. Literature describing pharmacological treatment, medication management, and supportive care strategies for adults with SMI receiving systemic anti-cancer treatments (SACT) were screened. Interventions identified were categorised according to their focus which included reducing experienced comorbidities, pharmacological interactions, and the specific challenges of dual diagnosis.
Results
Preliminary analysis of literature identified multiple opportunities for pharmacological interventions. Key actionable findings include proactive management of drug–drug interactions between psychotropic and anticancer and supportive medicines, mitigation of corticosteroid-induced psychiatric adverse effects via corticosteroid-sparing, improved clozapine-associated neutropenia risk management, smoking cessation-related dose adjustments, and structured deprescribing. Furthermore, results identified essential monitoring requirements for QT-interval prolongation and metabolic complications to consider concurrently with standard cancer protocols.
Conclusion
Pharmacological interventions remain a critical, under-utilised component of cancer care for patients with SMI. These findings provide a foundation for the development of a clinical guideline integrating evidence-based pharmacological interventions alongside psychosocial, provider, and system level domains to reduce treatment disparity and improve patient-centered outcomes.