Grant Number:	1R01CA311948-01 Interpret this number
Primary Investigator:	Irwin, Kelly
Organization:	Massachusetts General Hospital
Project Title:	Improving Cancer and Tobacco Cessation Care for Individuals with Serious Mental Illness
Fiscal Year:	2026

Serious mental illness (SMI) including schizophrenia, bipolar disorder, and severe major depression affects more than 15 million U.S. adults who die 15-25 years earlier than the general population. More than 50% of adults with SMI smoke4; smoking-related illnesses account for >70% of that mortality gap. Adults with SMI are less likely to receive tobacco cessation treatment and guideline-concordant cancer care and 2-4 times more likely to die from many common cancers. Diagnostic delays and differences in cancer treatment contribute to poor cancer survival. Patient, clinician, and systems factors impact cancer outcomes: high smoking rates can increase cancer recurrence; untreated psychiatric illness can impair prognostic understanding, and inadequate access to care. Clinicians lack cross-disciplinary training, psycho-oncology services remain inadequate, and clinical trials exclude patients with SMI. The time of cancer diagnosis is a critical opportunity to improve cancer care delivery and outcomes for all patients with SMI. Early, integrated mental health care protects against cancer care disruptions for people with SMI, however, many patients with SMI lack mental health care. Collaborative Care improves depression cost-effectively for patients with cancer but has excluded patients with SMI. We developed and piloted BRIDGE, person-centered collaborative care for SMI and cancer. We completed the first randomized trial (n=120) for SMI and a new cancer. BRIDGE was feasible (85% consented) and delivered remotely during the pandemic. Compared to enhanced usual care (EUC), patients on BRIDGE had fewer cancer care disruptions (treatment delays, deviations from guideline-concordant cancer care, treatment interruptions; 17% vs. 35%, p<.035) and decreased psychiatric illness severity. We conducted a 2-site RCT that found that adults with SMI can benefit from virtual tobacco cessation counseling beginning at cancer diagnosis. One critical next step is increasing reach to community settings. Guided by a stakeholder coalition, we now propose a Hybrid Type I effectiveness-implementation trial of BRIDGE-FREE which integrates tobacco cessation into person-centered collaborative care across the MGH and Dana-Farber networks (n=248). We will determine the impact on cancer care disruptions, tobacco cessation, and psychosocial outcomes and identify barriers to implementation. The overarching goal is to inform scalable approaches that address modifiable causes of premature cancer mortality.





None