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

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.