Proactive Psychiatry Consultation for Patients With Cancer and Severe Mental Illness
| Status: | Completed |
|---|---|
| Conditions: | Breast Cancer, Lung Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Depression, Schizophrenia, Major Depression Disorder (MDD), Psychiatric, Psychiatric, Bipolar Disorder |
| Therapuetic Areas: | Oncology, Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/7/2018 |
| Start Date: | November 9, 2015 |
| End Date: | November 1, 2017 |
Individuals with severe mental illness (SMI) including schizophrenia and bipolar disorder are
dying younger than the general population; cancer is a leading cause of death in this
population. People with SMI have higher rates of dying from breast, lung, and colon cancer,
and disparities in treatment appear to be one contributing factor. Individuals with SMI may
be diagnosed with more advanced stage cancer and less likely to receive stage-appropriate
cancer treatment. Although collaborative care models integrating medical and psychiatric care
have shown promise in other populations, the challenge of treating SMI and cancer is distinct
and relatively understudied. Patients may have uncontrolled psychiatric symptoms that can
impact their understanding of their diagnosis and treatment decisions. Oncologists have less
training and inadequate time to address multiple unmet needs. Mental health care is
frequently fragmented from cancer care.
The investigators want to understand if it is helpful for patients with SMI to be connected
to a psychiatrist and case manager when cancer is diagnosed. Optimizing psychiatric symptoms
and facilitating communication between the patient, the oncology team, and mental health
providers may improve care. The goal is to pilot a pragmatic intervention for patients with
cancer and SMI that can be integrated into cancer care, is acceptable to patients and
oncology clinicians, and may promote the delivery of stage-appropriate cancer treatment to an
underserved population.
Patients will be connected to a psychiatrist and case manager at cancer diagnosis who will
follow the patient and communicate with the oncology team during the 12 week intervention.
All participants will complete brief surveys at baseline, 4 weeks, and 12 weeks. Oncology
clinicians will provide feedback about the intervention at 12 weeks. Cancer treatment
received and healthcare utilization will be assessed at 6 months post-intervention.
dying younger than the general population; cancer is a leading cause of death in this
population. People with SMI have higher rates of dying from breast, lung, and colon cancer,
and disparities in treatment appear to be one contributing factor. Individuals with SMI may
be diagnosed with more advanced stage cancer and less likely to receive stage-appropriate
cancer treatment. Although collaborative care models integrating medical and psychiatric care
have shown promise in other populations, the challenge of treating SMI and cancer is distinct
and relatively understudied. Patients may have uncontrolled psychiatric symptoms that can
impact their understanding of their diagnosis and treatment decisions. Oncologists have less
training and inadequate time to address multiple unmet needs. Mental health care is
frequently fragmented from cancer care.
The investigators want to understand if it is helpful for patients with SMI to be connected
to a psychiatrist and case manager when cancer is diagnosed. Optimizing psychiatric symptoms
and facilitating communication between the patient, the oncology team, and mental health
providers may improve care. The goal is to pilot a pragmatic intervention for patients with
cancer and SMI that can be integrated into cancer care, is acceptable to patients and
oncology clinicians, and may promote the delivery of stage-appropriate cancer treatment to an
underserved population.
Patients will be connected to a psychiatrist and case manager at cancer diagnosis who will
follow the patient and communicate with the oncology team during the 12 week intervention.
All participants will complete brief surveys at baseline, 4 weeks, and 12 weeks. Oncology
clinicians will provide feedback about the intervention at 12 weeks. Cancer treatment
received and healthcare utilization will be assessed at 6 months post-intervention.
Specific Aims:
Aim 1: To evaluate the feasibility and acceptability of proactive psychiatry consultation and
case management among individuals with SMI treated at the MGH Cancer Center and their
oncology clinicians.
Aim 2: To describe the rates of receipt of stage-appropriate cancer treatment and patterns of
healthcare utilization in patients with SMI and cancer who are receiving the intervention
Aim 3: To explore patterns of change in psychiatric symptoms, quality of life, illness
understanding, and alliance with the oncology clinician in patients with SMI and a recent
cancer diagnosis who are receiving the intervention.
Aim 1: To evaluate the feasibility and acceptability of proactive psychiatry consultation and
case management among individuals with SMI treated at the MGH Cancer Center and their
oncology clinicians.
Aim 2: To describe the rates of receipt of stage-appropriate cancer treatment and patterns of
healthcare utilization in patients with SMI and cancer who are receiving the intervention
Aim 3: To explore patterns of change in psychiatric symptoms, quality of life, illness
understanding, and alliance with the oncology clinician in patients with SMI and a recent
cancer diagnosis who are receiving the intervention.
Inclusion Criteria:
- Individuals with a diagnosis of a primary psychotic disorder (schizophrenia,
schizoaffective disorder, delusional disorder), bipolar disorder, or major depressive
disorder with prior psychiatric hospitalization, confirmed by diagnostic assessment of
the PI, a psychiatrist with expertise in SMI and cancer
- Within 8 weeks of initial oncology consultation at the MGH Cancer Center (patients who
come for a second opinion and opt to have their cancer treatment at MGH will be
considered eligible, patients who have been treated previously for other types of
cancer will be considered eligible).
- Age >18 years old, verbal fluency in English
- Suspected or newly diagnosed lung, GI, head/neck, or breast cancer documented in
initial oncology note or confirmed by pathology
Exclusion Criteria:
- Cognitive impairment severe enough to interfere with completing the study assessments
or providing informed consent
- History of dementia or traumatic brain injury
- Refuse participation
We found this trial at
1
site
185 Cambridge Street
Boston, Massachusetts 02114
Boston, Massachusetts 02114
617-724-5200
Principal Investigator: Kelly Irwin, MD
Phone: 617-643-4453
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