Evidence Base for Collaborative Care in Cancer Treatment

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About 1.7 million people are diagnosed with cancer each year and over 14 million people currently live with a cancer diagnosis in the United States. As treatments have advanced to help cancer patients live longer, with over two-thirds of those diagnosed surviving 5 years or more, there is now increasing attention on maintaining quality of life. An important part of this goal is optimizing the emotional well-being of a patient as well as his/her physical health through the integration of psychosocial care into oncology care.

A growing number of randomized, controlled trials have shown the adaptability of Collaborative Care to cancer treatment settings. A recent meta-analysis of published studies in diverse oncology patient populations and settings showed that Collaborative Care is effective in meeting the psychosocial health needs of cancer patients, including low-income and racial and ethnic minority patients, and is cost-effective. The model has been shown to have many advantages over usual care for improving psychosocial health outcomes and quality of life. Furthermore, studies of Collaborative Care show heightened adherence to treatment and longer-term benefits compared to studies of medications or psychotherapy alone.

Collaborative Care’s focus on patient-centered and population-based care is consistent with today’s health care environment. It provides centralized psychosocial care, increasing convenience for cancer patients. A care manager, supervised by a psychiatrist with expertise in treating cancer patients, located within the oncology clinic works closely with oncology, primary care, and other supportive care providers to create a multidisciplinary and cohesive team that can deliver comprehensive and holistic care. Social workers, nurses, or psychologists can fill the role of the care manager, increasing the flexibility of the model. Collaborative Care uses evidence-based  pharmacological and behavioral strategies and validated treatment response outcomes, complementing the multidisciplinary, measurement-based nature of oncology care.

Technology, in combination with Collaborative Care, has been shown to increase the accessibility of psychosocial care to cancer patients. Telehealth and remote Collaborative Care teams can overcome the barriers presented by shortages in psychosocial specialists. The Collaborative Care model is highly flexible, making it sustainable and adaptable in diverse cancer care settings. 

Using Collaborative Care in cancer treatment has proved effective in real world settings as well as in research trials. The Seattle Cancer Care Alliance (SCCA) is one of the few cancer centers in the country that has integrated psychosocial care into routine cancer care using the Collaborative Care model. Led by faculty from the UW Department of Psychiatry and Behavioral Sciences, the Integrated Psychosocial Oncology Care program has successfully used Collaborative Care to improve patient outcomes and satisfaction, as well as provide the most holistic and compassionate care possible. 

Learn more about Training in the Integrated Psychosocial Oncology Program Model.

Resources

1.  Fann JR, Ell K, Sharpe M. Integrating psychosocial care into cancer services. Journal of Clinical Oncology 30:1178-1186, 2012

2. Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psycho-Oncology. 2016 Sep 19. [Epub ahead of print]

3. Fann JR, Sexton J. Collaborative Psychosocial Oncology Care Models. In: Psycho-OncologyTextbook, Third Edition. Holland JC, Breitbart W, Butow P, Jacobsen PB, Loscalzo M, McCorkle R (eds), Oxford University Press, NY, 2015

4.  Fann JR, Fan MY, Unutzer J. Improving primary care for older adults with cancer and depression. J Gen Intern Med. 2009;24 Suppl 2:S417–24. PubMed.

5.  Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J, et al. Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet. 2008;372(9632):40–8. PubMed.

6.  Ell K, Xie B, Quon B, Quinn DI, Dwight-Johnson M, Lee PJ. Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol. 2008;26(27):4488–96. PubMed.

7.  Sharpe M, Walker J, Holm Hansen C, Martin P, Symeonides S, Gourley C, et al. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet. 2014;384(9948):1099–108. PubMed.

8.  Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol. 2014;15(10):1168–76. PubMed.

9.  Kroenke K, Theobald D, Wu J, Norton K, Morrison G, Carpenter J, et al. Effect of telecare management on pain and depression in patients with cancer: a randomized trial. JAMA. 2010;304(2):163–71. PubMed.

10. Duarte A, Walker J, Walker S, Richardson G, Holm Hansen C, Martin P, Murray G, Sculpher M, Sharpe M. Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer. J Psychosom Res. 2015 Dec;79(6):465-70.

11.  Ell K, Xie B, Kapetanovic S, Quinn DI, Lee PJ, Wells A, Chou CP. One-year follow-up of collaborative depression care for low-income, predominantly Hispanic patients with cancer. Psychiatr Serv. 2011 Feb;62(2):162-70.