How a Virtual Behavioral Health Program Is Reaching Patients With Cancer Who Need It Most

A cancer diagnosis takes a psychological toll that's well documented but rarely well addressed. Most patients who need behavioral health support never get it, and the patients most likely to be left out are often the ones already facing the steepest climb. A new study presented at the 2026 ASCO Annual Meeting, led by Nina Balanchivadze, MD, FACP, of hematologist/oncologist at Sarah Cannon Research Institute at Virginia Oncology Associates, and Kyle Lavin, MD, MPH, of the University of North Carolina at Chapel Hill, set out to see whether embedding virtual behavioral health care directly into community oncology practices could close that gap.

"I think that the unmet needs that we're primarily trying to address are the whole-person care and the psychosocial support for patients living with cancer,” Lavin said. The scale of the problem, in his view, is the real starting point. "We know that 60% to 80% of patients who have a serious cancer diagnosis have some level of distress, and we know that typically less than 10% of patients access this type of care."

That gap isn't evenly distributed. "Our study that we presented at ASCO showed that the Medicaid population specifically presents with higher levels of depression and anxiety and lower levels of quality of life," Lavin added. The logic behind the intervention follows directly from that finding. "By integrating this behavioral health directly into the oncology workflow, into the oncology practices, these patients—all patients—are more likely to access care, but especially the underserved populations are more likely to enroll." The reach achieved bears that out, he noted, with BIPOC patients making up 43.5% of the study population.

Inside the Study Design

The study tracked patients across community oncology practices who were referred into a virtual collaborative behavioral health model run by a service called Cerula Care, of which Lavin is the co-founder and chief medical officer. "We looked at patients in a community oncology practice setting who initiated care for their oncologic conditions, and a referral was made for the collaborative behavioral care model,” Balanchivadze explained. "Cerula Care received the referrals, enrolled the patients, and measured patients in different key factors…[including] depression, anxiety, and quality of life."

Beyond symptom tracking, the study also looked at downstream behavior. "In addition to that, [we] measured patient satisfaction and adherence to visits, oncology care visits, and adherence to medications or prescribed treatments. This was measured at baseline and then measured longitudinally,” Balanchivadze said.

In practice, the numbers behind that design were substantial: 1400 patients were referred into the program by oncology providers, 850 consented and scheduled an intake, and 631 ultimately completed intake and began behavioral health care.

What the Data Showed

The headline finding, for Balanchivadze, was reach. Among the 631 patients who initiated care, 36.5% identified specifically as Black, and the Medicaid figure landed at 18.7%—both notably higher than these groups' typical representation in behavioral health services.

Symptom severity at intake told its own story. "We looked at the severity of symptoms upon presentation, both for BIPOC and for the Medicaid population. [It] was slightly higher for BIPOC, although not [statistically] significant," Lavin said, "[whereas] for the Medicaid population, there were statistically significant higher levels of depression, as measured by the PHQ-9; anxiety [as] measured by the GAD-7; and lower levels of quality of life [as] measured by the FACT-G7."

What stood out most, though, was what happened after patients entered care. "Those patients, even though they had higher distress, actually improved equally—if not directionally greater improvement—in those reductions in depression, anxiety scores, and improvement in quality of life scores," Lavin said. In other words, patients who started out worse off didn't fall further behind. If anything, the data trended the other way. Patient-reported satisfaction was high as well, with a Net Promoter Score of 88, and a majority of patients reported improved adherence both to oncology visits and to nonchemotherapy medications.

Why Community Oncology Is the Right Setting for This Work

For Balanchivadze, a practicing community oncologist, the choice to study this model specifically in the community setting, rather than at a large academic center, wasn't incidental. "I think the significance is huge," she said, "because at the community level, there are so many patient-related stressors... even physical distance to the oncologist's office. I see a lot of patients who live in remote areas, where even driving to the appointment to see me is a problem." Layering additional services on top of that baseline difficulty compounds the challenge. "If you layer on other services, such as behavioral health or referral to different specialists, it really becomes a challenge for the patients."

Community practices also tend to serve a broader cross-section of patients than academic centers do, Balanchivadze noted, which has its own implications for access and trust. "In the community, you also see a variety of a larger basket of different patients at different educational levels and different socioeconomic statuses—while at larger academic centers, one may see patients who are higher socioeconomic status, perhaps [allowing] them to seek care at tertiary centers." In the community setting, that range is wider. "We get patients that enter care at different levels of education, income levels, and various disparities.” Those differences, she said, can shape something as fundamental as whether a patient sticks with treatment. "That can be a contributor to adherence of the care that they receive. Trust is important as well. When [a patient] goes to a large academic center, there might be a different level of trust [in] the services provided there compared with smaller community settings.”

Lavin framed the program's value in the community setting in similarly direct terms. "It's transformational to be able to bring this access to the community oncology setting," he said, noting that many community practices simply don't have dedicated psychosocial oncology resources on hand. "A lot of community oncology groups don't have as much of the psychosocial oncology support resources." He’s careful to credit the existing infrastructure that does exist alongside the new model. "We work very closely with the [practice's] social work team. They do an amazing job of caring for the patients they're able to see." But the broader goal, he said, is to shift the posture of care from reactive to proactive. "Through this model, [we're] trying to expand access, both to the underserved population and also across the entire population, and [help] patients... be much more proactive in preventing distress, rather than reactive and waiting until distress occurs, and then we [are] dealing with a crisis."

Open Questions Going Forward

Asked what remains unanswered, Balanchivadze returns to a concern central to her day-to-day practice: medication and visit adherence. "As an oncologist, adherence is huge," she said. "I think integrating behavioral health and proactively screening patients for adherence, and then seeing how it affects adherence to oral oncolytics, chemotherapy, or oncology visits. Because we know adherence translates into better outcomes."

The second concerns clinical trial participation. "Improving mental health resources and access to mental health, integrating into oncology care—how is that going to affect trial enrollment and participation in clinical trials?” Balanchivadze asked.

REFERENCE

Balanchivadze N et al. Advancing health equity in oncology: Virtual collaborative behavioral health engagement and outcomes among Medicaid-insured and BIPOC patients. J Clin Oncol. 44, 1552-1552(2026). doi:10.1200/JCO.2026.44.16_suppl.1552