adapting the tumor board model for mental illness and cancer

Conditions: Cancer; Severe Major Depression; Schizophrenia; Bipolar Disorder; Lung Cancer; Breast Cancer; Head and Neck Cancer; Gastrointestinal Cancer; Genitourinary Cancer

Summary: this study examines the feasibility and acceptability of a virtual tumor board for cancer and mental illness for patients with serious mental illness and a new cancer diagnosis. the study also examines the impact on patient care, psychiatric symptoms, and clinician self-efficacy in managing this population.

individuals with serious mental illness (smi) experience increased cancer mortality because of inequities in cancer care. access to mental health and cancer care remains inadequate. virtual tumor boards have been associated with higher rates of patients receiving guideline-concordant cancer care, but these tumor boards have not been adapted for cancer and mental illness. a virtual cancer and mental health tumor board intervention has potential to increase access to psycho-oncology and oncology expertise, facilitate clinician communication, and may address barriers to cancer and mental health care. the purpose of this study is to examine the feasibility and acceptability of a virtual tumor board for cancer and mental illness for our target population for patients and clinicians. we will also explore changes in cancer care, psychiatric symptoms, and clinician self-efficacy in managing this population. this study is a single-arm pilot (n = 30) based at a cancer center affiliate and the surrounding community. the intervention includes proactive identification using a registry, bi-monthly virtual equity tumor board focused on cancer and mental health using hipaa-compliant videoconference that uses co-learning, assessment of barriers to cancer care, strengths, and goals of care, creating plans that identify who is responsible for next steps and patient communication, and relaying recommendations to patients and the treating oncology team.

Eligibility criteria:
inclusion criteria: 1. age ≥ 18 years old 2. verbal fluency in english 3. smi (schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder with either prior psychiatric hospitalization, history of suicide attempt/suicidal ideation, medicaid insurance, and/or comorbid alcohol or opioid use disorder) confirmed by diagnostic evaluation of study psychiatrist 4. new invasive stage i-iv breast, lung, gastrointestinal, genitourinary, or head and neck cancer (highly suspected or confirmed according to documentation by the oncologist or pathology) 5. oncology consultation at or referral to a mgh danvers within the past 8 weeks exclusion criteria: 1. have cognitive impairment severe enough to interfere with completing brief study assessments or providing informed consent and does not have a guardian who can provide consent 2. recurrence of same cancer type 3. do not have verbal fluency in english

Keywords: cancer care major depression and cancer schizophrenia and cancer bipolar disorder and cancer lung cancer breast cancer head and neck cancer gastrointestinal cancer genitourinary cancer schizophrenia bipolar disorder major depression health equity mental disorders