Grant Number:	1R37CA300110-01 Interpret this number
Primary Investigator:	Irwin, Kelly
Organization:	Massachusetts General Hospital
Project Title:	Improving Care Delivery for Individuals with Mental Illness and Cancer Across a Cancer Center Network.
Fiscal Year:	2025

This trial is designed to improve cancer and mental health care delivery for adults affected by serious mental illness (SMI). Adults with SMI, including schizophrenia, bipolar disorder, and major depressive disorder, experience delays to cancer diagnosis and gaps in cancer treatment that contribute to premature cancer mortality. Patient, clinician, system, and policy-level factors contribute to poor cancer survival for adults with SMI. Despite the urgent need to identify evidence-based approaches to improve cancer care for adults with SMI, this population has been excluded from cancer clinical trials. Proactive psychiatry consultation has potential to address modifiable drivers of lower quality cancer care and outcomes for adults with SMI, however, most cancer centers lack psycho-oncology care. Collaborative Care is a population and team-based model with strong evidence for improving depression treatment for patients with cancer and increasing access to care, but this model has not been adapted for SMI. Informed by qualitative research, we developed and successfully piloted the BRIDGE model of person-centered collaborative care for SMI and cancer. BRIDGE includes proactive psychiatry consultation, engagement of a social work care manager, a person-centered approach across care settings and co-management with oncology. We developed sustainable systems to proactively identify adults with SMI and a rigorous methodology to evaluate disruptions in cancer care, and adapted trial procedures to ensure accessible for all patients. Next, we conducted the first randomized trial for adults with SMI at the time of cancer diagnosis (n=120). Patients on BRIDGE had significantly fewer disruptions in their cancer care (primary outcome, p<0.035) and decreased severity of psychiatric illness and anxiety (p=0.02). Additionally, we developed pragmatic ways to deliver the intervention remotely and engage a population facing multi-level barriers to technology use. One critical next step is to increase the reach of BRIDGE to community cancer settings without embedded psycho-oncology services where most patients with cancer receive care. We aim to address this gap by increasing the reach of the BRIDGE intervention across a statewide cancer center network. First, we will use community-engaged research strategies to tailor intervention procedures and workflows to the affiliate site and surrounding community while retaining core intervention components. Next, we will conduct a Hybrid Type I effectiveness-implementation randomized trial (n=248) across the cancer center network and determine the impact on cancer care disruptions and patient-reported outcomes. Additionally, we will conduct a mixed methods analysis of facilitators and barriers to implementation. The overarching goal is to develop a scalable intervention that increases access to expert care and addresses a modifiable driver of cancer mortality and morbidity.





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