Exploring the Intersection of Cancer, Domestic Homicide, and Domestic Abuse-Related Suicides Using Domestic Homicide Reviews

Abstract

Purpose
Research about the overlap between cancer and domestic abuse (DA) is limited. We analyzed Domestic Homicide Review (DHR) reports from England and Wales where the victim or perpetrator had a cancer diagnosis to investigate the nature of DA in a cancer context, and cancer care and other healthcare professionals’ (HCPs) responses to DA.

Methods
We adopted the READ approach to document analysis: Readying materials (including manually searching reports for the term ‘cancer’); Extracting data; Analyzing data; and Distilling findings (using thematic analysis). We framed results using the social-ecological model of violence.

Results
We retrieved 24 DHR reports, which covered 27 domestic homicides/DA-related suicides. Victims had cancer diagnoses in 15/27 cases, perpetrators in 8/27, and both in 1/27. Three cases involved two homicides. Victims were mostly older (median 67). Most (19/24) domestic homicides/DA-related suicides occurred within 3 years of diagnosis, yet cancer HCPs rarely made explicit contributions to the DHR process. Our qualitative themes explain how: (1) cancer and DA affected each other; (2) professionals missed opportunities to identify and respond to DA (including because cancer masked DA indicators, turning down care and support offers were underrecognized indicators, and care was fragmented and non-holistic with insufficient information-exchange); and (3) cancer diagnoses were under-considered and misunderstood in the DHR process.

Conclusions
Since cancer masked DA indicators, professionals working with affected people and families should have a low threshold for concern. More explicit contributions to DHRs by cancer HCPs may improve understanding of this intersection and improve future practice.