Breaking Down Silos
Event organizers Kelly Irwin, MD, and Amy Corveleyn, MSW, with leadership sponsor David Ryan, MD (MGH), and symposium speakers, panelists and attendees, celebrated a positive step in breaking down the silos between cancer careand mental health care. The May 5th symposium “Bridging the Divide: Mental Health and Cancer Care,” organized by the Massachusetts General Hospital Cancer Center with support from Dana-Farber/Harvard Cancer Center (DF/HCC), brought together 140 participants including patients, families, oncologists, psychiatrists, community mental health physicians, advocates, and policy makers hailing from 30 different institutions.
During the half-day event at the Wyndham Beacon Hill Hotel, attendees listened to talks, participated in workgroups, and discussed how to better support each other. The diverse group also generated priorities and action steps to improve cancer care for patients with mental illness. “One of the highlights of the symposium,” remarked Jennifer Temel, MD (Thoracic Oncologist, Director of the MGH Cancer Outcomes Research Program, and co-leader of the DF/HCC Cancer Care Delivery Program), facilitator of the event’s End-of-Life Care workgroup, “was bringing together all of the types of clinicians who care for patients with serious mental illness and cancer to share our experiences, expertise, and challenges caring for this population.”
2-3 Times More Likely to Die and Die 30 Years Earlier…
If bringing oncologists and mental health professionals together was the primary goal of the event, a secondary objective was to emphasize the disparities in cancer outcomes for this population and the need for additional research. Dr. Irwin, psychiatrist, health services researcher, and Director of the Collaborative Care and Community Engagement Program at MGH, emphasized, “Compared to patients with no mental illness, those with schizophrenia, bipolar disorder, and severe major depression die 30 years earlier and are 2-3 times more likely to die from many common cancers.” However, she noted that this population has been largely neglected from cancer research. Dr. Irwin recently conducted a successful pilot study of an innovative model of integrated psychiatry and cancer care for patients with serious mental illness, and is preparing to conduct the first randomized trial focused on this issue.
During discussions at the symposium, clinicians shared stories about patients with mental illness who refused treatment for treatable cancers,comparing best practices for handling these situations. The consensus in the room was that spending more time with patients and/or bringing mental health clinicians into the care team increased the probability that patients would get the treatment they needed.
Corveleyn, Clinical Social Worker and Case Manager/Social Worker for the Collaborative Care and Community Engagement Program at MGH, stated that a goal for the symposium was to try to dispel the misconception that those with mental illness will refuse cancer treatment. “They sometimes need a little more support, but it doesn’t mean that they don’t want or can’t complete treatment,” she said.
One clinician in the audience noted, “Sometimes it is important to unpack the word ‘no’”, explaining further that often the reasons behind the word ‘no’ can be addressed individually, leading to eventual acceptance of treatment.
Others explained that patients sometimes feel stigmatized by clinicians for having a mental illness and worry that their wishes might be overshadowed by the misconceptions about mental illness. Despite the varieties of scenarios discussed, one thing was clear: mental illness complicates the diagnosis and treatment of cancer. “At the end of the event there was a feeling of being energized” Irwin noted, and she hopes that this will lead to further inroads into this difficult, but surmountable challenge.
“I was really excited by some of the ideas that came out of the symposium,” Irwin added, “specifically ‘Cross Education’.” She went on to describe her vision for a day-long symposium where palliative care clinicians, oncologists, and nurses teach Cancer 101 to community mental health clinicians, then the roles flip to community mental health clinicians teaching Mental Health 101 to cancer center clinicians and staff.
“We’re carefully reviewing the evaluations that attendees completed, and hope this symposium can be an annual event given the desire for collaboration and unmet patient need.” Corveleyn explained when asked about the potential for a 2018 symposium. Overwhelming support and positive reviews have the organizers considering a larger 2018 event, noting that many who expressed interest in attending the May 2017 symposium had to be turned away due to space limitations. The organizing team expressed their appreciation of support from DF/HCC and MGH Cancer Center to develop a symposium focused on a neglected population. The event was a great step toward building a community of stakeholders who are committed to improving cancer outcomes for patients with mental illness.
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