For decades, the standard of care in oncology has prioritized the defeat of the disease. While medical advancements have transformed cancer into a complex, chronic illness for many, they have left a significant gap in clinical responsibility. The reality is that cancer is a profound psychological and systemic crisis, demanding an integrated response.
This demands an intentional shift in focus from behavioral health leaders: treating the patient’s physical body without intentionally treating the person, their family, and their emotional landscape is incomplete medicine. The integration of behavioral health into oncology, known as psycho-oncology, is not an optional add-on; it’s a clinical and systemic necessity for achieving true whole-person cancer care. This transition requires crucial leadership and a commitment to operationalizing evidence-based models.
The Crisis of Care: The Unmet Need
The data paints a stark picture of the immense and often unmet psychological need in oncology: While many patients experience distress that warrants clinical intervention, studies show that an estimated 70 percent of cancer patients experiencing psychological distress do not receive appropriate behavioral health care (Sharpe et al., 2014).
Ignoring this distress has critical consequences beyond emotional suffering, impacting quality of life and survivorship outcomes. Behavioral health leaders must understand the full scope of the clinical imperative, which includes addressing four major areas of distress:
- Clinical Disorders: The high prevalence of diagnosable conditions, with up to 40% of patients meeting criteria for mood or anxiety disorder during treatment (Shalata et al., 2024). This often includes depression, generalized anxiety, and cancer-related Post-Traumatic Stress Disorder (PTSD).
- Existential and Identity Distress: Cancer disrupts identity, sense of purpose, and life plans. Fear of recurrence (known as “scanxiety”), grief, and demoralization are pervasive issues that require specialized psychosocial support.
- Financial Toxicity: The immense cost of cancer care is a recognized stressor that contributes to psychological distress, treatment non-adherence, and diminished quality of life.
- Caregiver Burden: The crisis extends to the family unit. Caregivers often experience significant rates of depression, anxiety, and physical exhaustion; their untreated distress can compromise the patient’s ability to adhere to treatment. Our model must inherently treat the whole family system.
For behavioral health leaders, this pervasive unmet need translates to a clear mandate: we must close this 70% gap by moving from reactive, disjointed referrals to proactive, embedded, and technology-enabled support.
Actionable Strategies for Behavioral Health Leaders
To move beyond fragmented care and champion the whole-person model, leaders must focus on three core areas:
1. Implement Technology-Integrated Screening and Triage – The greatest barrier to psycho-oncology care is often the lack of identification and seamless referral at the point of care. Leaders must prioritize partnerships that integrate behavioral health directly into the oncology treatment workflow via technology platforms.
- The Technology Integration Model: This system involves embedding behavioral health assessments and clinical guidelines directly into the oncology electronic health record (EHR) or clinical decision support system. This technology-enabled approach ensures that distress is treated as the “sixth vital sign,” making screening mandatory and consistent.
- Real-Time Intervention: The integration allows the system to utilize patient-reported distress scores and clinical data to trigger flags. It can automatically generate suggested behavioral health actions for oncologists and facilitate direct, closed-loop referral and monitoring without relying on external faxes or fragmented communication.
2. Operationalize the Collaborative Care Model (CoCM) – For scalable and efficient support within large oncology centers and community practices, the Collaborative Care Model (CoCM) provides the necessary structure. This goes beyond simple co-location; it requires true operational integration in two phases:
- Implementing the CoCM Blueprint: establishing a structured care management system with specialized roles: the primary cancer care team, the behavioral health care manager, the consulting psychiatrist, and the patient.
- Scope, Value, and Monitoring: ensures the support goes beyond simple talk therapy to include proactive, stepped-care monitoring, evidence-based interventions for sub-threshold symptoms, and psychiatric consultation for medication management. This is the gold standard for delivering effective psychosocial care in chronic illness settings and is incentivized under value-based care programs like the Enhancing Oncology Model.
3. Prioritize Specialized Training and Policy Advocacy – Effective psycho-oncology requires a specialized skillset that extends beyond generalist behavioral health practice.
- Training Imperative: Leaders must invest in training for their behavioral health staff in psycho-oncology principles, including the management of treatment side effects (e.g., steroid-induced mania), end-of-life concerns, and navigating oncological prognosis and language. This is vital to ensure that embedded providers are truly integrated and effective partners.
- Policy Advocacy: Behavioral health executives must advocate for pay policies that adequately reimburse the integrated, time-intensive services required by CoCM. Systemic adoption requires payer policies that fully align reimbursement with the immense value of coordinated care.
A Shared Vision for Leadership
The whole-person imperative is the next frontier in quality cancer care. Our role as behavioral health leaders is to make sure that emotional and mental support is seamless, efficient, and evidence based. By championing technology integration, implementing the Collaborative Care Model, and investing in specialized training, we can treat the whole person, close the 70% gap in care, and ensure that every patient feels seen, heard, and cared for in every part of their cancer journey.
Josh Myers, PhD, LPC-S, is the CEO of Adjuvant Behavioral Health, a national leader in providing collaborative behavioral health support for patients and families facing cancer and other chronic illnesses. Learn more by visiting AdjuvantBH.com.
References
Shalata, W., Gothelf, I., Bernstine, T., Michlin, R., Tourkey, L., Shalata, S., & Yakobson, A. (2024). Mental Health Challenges in Cancer Patients: A Cross-Sectional Analysis of Depression and Anxiety. Cancers (Basel), 16(16), 2827. doi: 10.3390/cancers16162827.
Sharpe, M., Walker, J., Holm Hansen, C., Martin, P., Symeonides, S., Gourley, C., Wall, L., Weller, D., & Murray, G. (2014). Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet, 384(9948), 1099–1108. doi: 10.1016/S0140-6736(14)61231-9.
