A cancer diagnosis can profoundly affect a person’s life and impact their overall mental health.
Roughly a third of all cancer patients also have a behavioral health issue, such as anxiety, depression, or a substance use disorder, according to research published in Translational Psychiatry. As a result, more payers and providers are looking for ways to better support oncology patients’ behavioral health needs.
“We know that if we want to improve clinical outcomes, an integrated strategy providing behavioral health with the oncology care in tandem definitely produces better outcomes,” Dr. Rodgers Wilson, a national medical executive for behavioral health at Evernorth, told Behavioral Health Business. “It also [provides a] better patient experience as they cope through cancer care.”
Evernorth is the health service division of large payer group Cigna (NYSE: CI). It offers a wide range of behavioral health and substance use disorder services, as well as physical health services, including oncology care.
The equity and business cases for oncology-behavioral health integration
A health equity case could also be made for integrating these two specialties.
“Integrated behavioral health care, especially in the oncology space, is absolutely a must when it comes to ensuring that there’s equity in cancer care,” Dr. Yasmin Asvat, an assistant professor in the department of Psychiatry & Behavioral Sciences at Rush University Medical Center, told BHB. “We know that there’s a higher proportion of mental health needs in some of our most vulnerable, underserved populations.”
Rush University Medical Center is a 671-bed hospital in Chicago. It offers 70 residency and fellowship programs in medical and surgical specialties and subspecialties.
Asvat noted that many patients with cancer who are living in underserved areas are also living with higher stress levels as well as behavioral health conditions. These factors can contribute to medication adherence challenges and outcomes.
“So this is not just a case for psychology and psychiatry [integration]. It’s a case for social work,” Asvat said. “It’s a case for care management. It’s the case for all the support services that are going to make sure that every person going through cancer is going to have access to the resources they need.”
Providing behavioral health services to oncology patients also makes financial sense, according to Wilson.
Oncology patients who do not receive behavioral health outpatient services are twice as likely to have an avoidable emergency room visit as those who do, according to the Evernorth Research Institute. The average additional costs range from $173 to $243 more per member per year for those not seeking behavioral health services.
“Oncology is one of the most expensive diagnoses for our clients, these different employers,” Wilson said. “But one thing we were able to highlight from the Evernorth Research Institute is that having a person engaged in behavioral health treatment significantly impacts avoidable ER visits.”
Models of implementation
While the benefits of integration are clear, there’s no one-size-fits-all approach.
“There’s a variety of models, and to some degree, the models that are implemented are highly dependent on the resources available to each individual cancer care-providing institution,” Asvat said.
For example, at Rush University Medical Center, the Support Oncology Program brings together a variety of specialists, including social workers, dietitians, chaplains, psychiatrists and psychologists, as well as physical medicine and rehab physicians.
“The communication here is key,” Asvat said. “The providers are placing referrals for our services. We’re seeing patients and communicating key elements of our recommendations to providers to ensure that all team members involved in that patient’s care are on the same page when it comes to behavioral health, management and goals.”
Some health plans are also beginning to support behavioral health and oncology integration. For example, Evernorth has incorporated behavioral health distress screenings into its oncology case management program. If a patient scores high for a particular concern, the case manager can connect them to a behavioral health coach, who can help set up an outpatient behavioral health appointment in the community.
Another crucial part of integrated care is educating providers on the oncology and behavioral health side of care.
“We want to make sure that behavioral health providers have an understanding of changes in oncology care, and be able to support that patient going through an oncology diagnosis,” Wilson said. “Not only have the diagnostic and regiments changed, but think about chemotherapy. We know some of the chemotherapy, for example, causes psychological complications. Some drugs may cause depression, but at the same time, that person needs to be treated for that cancer diagnosis. So making those behavioral health providers [knowledgeable] about complications and different treatment regimens is key.”
In addition to traditional behavioral health providers like social workers and psychologists, non-clinical behavioral health workers could be another resource for cancer patients.
“We connect patients to community support. So think about self-help groups and organizations for people who’ve survived breast cancer or people who are dealing with issues related to prostate cancer,” Wilson said. “So those resources are available in the community and our case management nurses can connect patients to non-specialized care if a person really wants more peer support.”
In particular, peer support services could be key to helping certain patient populations, such as teens and children.
“You could absolutely train peer supporters who have gone through childhood cancer to provide peer support to teenagers who are going through right now,” Obi Felten, founder and CEO of Flourish Labs, told BHB. “Oncology patients are extremely immunocompromised, so they are in the hospital for a long time where they are isolated from all human contact. And so giving them a tablet, and giving them peer support in their hospital bed is something that I’d be super interested to see if that could be effective.”
Flourish Labs uses technology to help scale professional peer support. It trains young adults to become certified peer support specialists and then pairs them with teens in need of help.
Peer support could also help the patient’s family unit deal with the cancer diagnosis. This is especially true with pediatric oncology cases where parents and siblings are involved in care.
“There’s the patients, but then there’s also the siblings,” Felton said. “There’s a child that is going through cancer treatment and the entire family’s focus is on that child and the siblings often get left behind.”