Here’s how—and why—oncologists should integrate mental health care

Lisa—an avid runner—was in her early 50s when she received a breast cancer diagnosis. During one appointment, she said “cancer ruined my life.”

Tara was a 38-year-old mother with a 2-year-old when she got a breast cancer diagnosis. Unable to sleep for three days after her first cycle of chemotherapy, she came into the exam room with tears in her eyes saying she felt like she could harm herself and her daughter.

Katie had a 15-year-old daughter she was raising on her own when she was diagnosed with breast cancer. But Katie’s biggest concern with her daughter’s anxiety and inability to cope with the stress of Katie’ diagnosis.

Those are just three of the stories that led to New England Cancer Specialists—a physician-owned and -led private practice serving patients in Maine and New Hampshire—to integrate a mental health program into their practice.

“Healing after a cancer diagnosis is only possible by addressing the needs of the entire person and we decided to invest in integrated support services,” said Chiara Battelli, MD, PhD, the group’s president and an oncologist. She spoke during the recent Behavioral Health Integration (BHI) Collaborative webinar, “Supportive Services in an Oncology Practice: Meeting the Patients Where They Are.”

The AMA established the BHI Collaborative with seven other leading physician organizations to help overcome persistent obstacles to integrating behavioral and mental health care into primary care practices and expand access to vital treatments for more patients. The collaborative now has 12 members after expanding to include a selection of non-primary care specialty associations who help manage longitudinal care for patients with chronic illnesses significantly affected by one or more comorbid mental health conditions.

The webinar, among other things, covered three steps that New England Cancer Specialists took to bring mental health care to their patients—steps that others can follow to integrate this care too.

In Dr. Battelli’s practice, patients fill out the Patient Health Questionnaire-2 every 90 days so she and her colleagues can assess whether patients need mental health support.

The practice also uses the National Comprehensive Cancer Network Distress Thermometer to check in with a patient when there is a change in the treatment regimen or if a new therapy is started. 

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When the physicians at New England Cancer Specialists decided to add mental health care to better support patients in 2021, they hired their first licensed clinical social worker (LCSW) to be available in-house.

Since then, NECS has added another full-time LCSW and a part-time LCSW. The practice plans to add an additional full-time LCSW by year’s end. 

As of February, the LCSWs have seen 747 patients for a total of 3,413 visits and offered counseling to 72 caregivers. The most common reasons for referral to the LCSW are adjustment disorder, depression, anxiety, substance-use disorder, nicotine dependence, anorexia, insomnia and phobias.

To meet their patients’ needs, New England Cancer Specialists’ programs for mental and behavioral health have grown to include:

• The Cancer Connections Program, which is a peer-to-peer program to connect patients who have experienced similar cancer diagnoses.
• A monthly meetup for patients 90 or older to combat social isolation.
• A support group for patients living with metastatic disease.
• A smoking-treatment program with the American Heart Association’s support.

And Dr. Battelli, an AMA member, said they hope to expand what they can offer in the future by incorporating a psychiatrist or psychiatry nurse practitioner, developing a geriatric oncology program and providing neurocognitive testing.

This involves discovering what other programs and resources are available in the area. New England Cancer Specialists has been able to create connections with two local programs:

• Dempsey Center, a nonprofit that offers counseling, support groups, movement and fitness and more for people impacted who are impacted by cancer.
• The Center for Grieving Children, a nonprofit that provides peer support, education and more for grieving children, teens, young adults and families.

In addition to mental and behavioral health support, New England Cancer Specialists provides other support services as well, including financial support, nutrition, health coaching and genetic counseling.

Explore ways to sustain a collaborative, integrated, whole-person, and equitable approach to physical and behavioral health care in physician practices with this series of instructive AMA and BHI collaborative webinars on behavioral health integration.

The BHI Compendium is a one-stop online collection of resources to help guide practices through the initial steps and considerations of delivering integrated behavioral care.