Recent studies by multidisciplinary teams at Memorial Sloan Kettering Cancer Center and Massachusetts General Hospital are illuminating novel ways to address health-care challenges faced by patients with cancer. The research, presented at the 2023 ASCO Quality Care Symposium, highlights the potential of integrated medicine and collaborative care to enhance patient outcomes, reduce health-care costs, and address critical gaps in mental health care.
The first study showcased a unique care delivery model for patients with cancer, focusing on the use of nonpharmacologic interventions such as fitness, yoga, and meditation to manage symptoms like fatigue and depression.1 Results of the Integrated Medicine at Home program revealed a substantial reduction in the number of urgent care visits per person and hospitalizations among patients with cancer who are undergoing active treatment, along with improvements in fatigue, depression, and other physical symptoms.
“Integrated Medicine at Home, a virtual mind-body-fitness program, can be a scalable solution that can be integrated into cancer care delivery to improve the symptom control for patients and reduce urgent care hospitalizations and save costs for the health-care systems,” said lead study author Jun J. Mao, MD, MSCE, the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
Jun J. Mao, MD, MSCE
According to Dr. Mao, despite growing evidence around the benefits of nonpharmacologic interventions such as fitness, yoga, and meditation in managing symptoms like fatigue and depression, these interventions are underused in cancer care, leaving a substantial gap in care delivery. To bridge this gap, Dr. Mao and colleagues designed the Integrated Medicine at Home study using a virtual mind-body fitness program aimed at decreasing unplanned hospitalizations and urgent care use among patients with cancer.
Integrated Medicine at Home Study Details
For this randomized clinical trial, the investigators used a novel basket study design among patients with a diagnosis of breast, thoracic, gynecologic, head/neck, or melanoma cancer who reported moderate or greater fatigue while receiving active cancer treatment. Eligible participants were randomly assigned to the intervention (choice of 20+ weekly virtual live mind-body and fitness classes) or enhanced usual care (standard of care plus access to 20+ prerecorded online meditation resources); they were on study for 12 weeks. The investigators analyzed the use of hospital services over the study period from electronic medical records and compared study arms.
Outcomes With Study Intervention
Although the proportion of patients requiring urgent care visits was similar between the study arms, said Dr. Mao, the number of urgent care visits per patient was reduced by half in the intervention arm vs enhanced usual care (rate ratio = 0.52). Over the 3-month period, patients randomly assigned to the Integrated Medicine at Home program averaged 1.2 urgent care visits vs 2.5 visits for patients who received enhanced usual care (P = .042). The proportion of participants who required hospitalization was also reduced by more than half (4.0% vs 12.9%, P = .025). The Integrated Medicine at Home program also led to appreciable improvements in fatigue, depressive symptoms, and physical symptoms.
“Overall, there were 130 days of hospitalizations with usual care vs 17 days with the Integrated Medicine at Home program,” Dr. Mao reported. This could potentially translate into a significant cost savings.
According to Dr. Mao, the trial is limited because of its short follow-up and broad eligibility criteria. However, he added, it sets the stage for more longitudinal studies in broader community settings and diverse patient population groups.
The BRIDGE Intervention: Cancer and Serious Mental Illness
A separate study presented at the 2023 ASCO Quality Care Symposium revealed a significant decrease in disruptions to cancer care for individuals with serious mental illness and cancer who received person-centered collaborative care.2 The BRIDGE intervention—a collaborative care approach involving proactive psychiatry consultation and a social work case manager who maintained communication with other health-care providers and caregivers—was also shown to reduce anxiety and the severity of psychiatric illness.
“Individuals with serious mental illness and cancer can participate in randomized clinical trials at academic cancer centers with pragmatic tailored approaches,” said Kelly E. Irwin, MD, MPH, Assistant Professor in Psychiatry at Harvard Medical School, and a faculty psychiatrist at the Massachusetts General Hospital (MGH) Cancer Center and MGH Schizophrenia Program. “This intervention worked to decrease cancer care disruptions associated with survival and quality of life,” she added.
Kelly E. Irwin, MD, MPH
As Dr. Irwin reported, cancer is the second leading cause of death among people with serious mental illness. “These individuals are not more likely to get diagnosed with cancer, but they are more likely to die of it,” she stated, noting that individuals with serious mental illness, such as schizophrenia, bipolar disorder, and severe major depression, live 25 fewer years, on average, than the general population. “Approximately 80% of that mortality gap is the result of mental and medical illnesses.”
The BRIDGE intervention was a single-site trial conducted in an academic medical center, enrolling 120 patients split evenly across two groups. Eligible patients had serious mental illness (schizophrenia spectrum, bipolar, or severe major depressive disorders) and potentially curable, newly diagnosed head/neck, lung, breast, or gastrointestinal cancer.
Patients were randomly assigned to the BRIDGE intervention or enhanced usual care. The primary outcome was clinically significant cancer care disruptions over 24 weeks (delays in treatment initiation, deviations from guideline-concordant care recommended or received, or interruptions in planned cancer treatment).
Fewer Disruptions in Cancer Care and Improved Mental Health
As Dr. Irwin reported, patients assigned to the BRIDGE intervention were significantly less likely to experience cancer care disruptions than those who received enhanced usual care (17.2% vs 35.1%, P = .035). Those who underwent the BRIDGE intervention also had significantly improved psychiatric illness severity and anxiety at the end of 24 weeks compared with patients who received enhanced usual care.
According to Dr. Irwin, multisite implementation effectiveness trials are needed to increase the generalizability of the intervention to community oncology settings. “I hope these trial approaches can be generalizable to other marginalized populations,” she concluded.
DISCLOSURE: Dr. Mao and Dr. Irwin reported no conflicts of interest.
REFERENCES
1. Mao JJ, Bryl K, Gillespie EF, et al: Effect of virtual mind-body fitness program on reduction in unplanned hospitalizations among patients undergoing active cancer treatments: A pragmatic randomized clinical trial. 2023 ASCO Quality Care Symposium. Abstract 473. Presented October 28, 2023.
2. Irwin K, Nipp RD, Shaqour SE, et al: BRIDGE: A randomized trial of person-centered collaborative care for adults with serious mental illness and newly diagnosed cancers. 2023 ASCO Quality Care Symposium. Abstract 216. Presented October 28, 2023.
