Embedded Psychosocial Care Improves Cancer Support

Dr. Ramy Sedhom sat down with CURE to discuss how integrating psychosocial oncology directly into cancer care teams is reshaping patient support and improving access to mental health services.

Sedhom is a medical oncologist and palliative care specialist at Penn Medicine, where he serves in multiple leadership roles including co-lead of Geriatric Oncology for the Penn Cancer Service Line and clinical director of Medical Oncology at Penn Medicine Princeton Health. He also serves as associate director of the Penn Center for Cancer Care Innovation, co-lead of Psychosocial Oncology Services at Princeton Health, division chief of the Palliative Care Division in Medical Oncology, and clinical assistant professor of medicine (Hematology-Oncology).

Transcript

How does improving access to psychosocial oncology clinics change the patient experience, particularly for those who might go without support?

Going back to national statistics, 50% of patients who are diagnosed with cancer experience some sort of mental health symptom. The biggest problem, aside from this being unrecognized, is that fewer than 20% of patients nationally have access to mental health support. This is due to a lot of reasons. Many of them are policy or reimbursement issues, but a real, fixable one is just how we are geographically located.

So, at our institution, thanks to a local donor who had his own unfortunate experience helping his mom live with cancer and seeing the mental health impact that can have on one and their extended family, we were able to kick-start a psychosocial oncology program at our institution. What I've noticed is that having therapists embedded in the clinic, really as a shared-care model, improves access, and I see this in real time in the clinic.

To give just a very pertinent example that honestly happens every day, I may be sitting with a patient who, let's say, is 40 years old, with a new diagnosis of breast cancer, has two young kids at home, and is very worried about what her future will look like because she is young and dependent on her health insurance and the income that comes with it. She has to manage balancing being a mom, working, and tolerating her cancer therapy. As you might imagine, many of our visits are not just a logical exchange, but an emotional connection.

While I, as an oncologist, try to play therapist, there is a lot of emotion and worry that often comes with a cancer diagnosis, and while I lean into that responsibility, I am not as equipped, for example, as a psychologist or a licensed clinical social worker.

What is really nice about an embedded program is that if I recognize my patient is in distress, instead of telling her, "Hey, I think you'd benefit from support; do you have a counselor?" — which most patients would not have access to in the community, again, due to cost, convenience, time, and toxicity — I can reach out to one of our many therapists who work in the clinic with us and say, "Hey, I know that you're really struggling today, and thank you for sharing how this is really impacting you. I'd like to call in my colleague to come and sit and chat with you to understand what's going on and how we can better help."

What’s nice about that, what we call a warm handoff, is that when we're embedded into the cancer care team, it not only signals that this is an important routine part of care, but it also allows that early touch point to happen in real time when the patient is feeling distress. This allows for a therapeutic connection.

What we've noticed is that adherence rates in our clinic are much higher than the national average, meaning those who are warmly welcomed to a psychologist are much more likely to engage in and complete care.

Transcript edited for clarity an conciseness

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