Scaling Whole-Person Care: Virtual Collaborative Models in Oncology

In part 3 of the interview, Nina Balanchivadze, MD, Sarah Cannon Research Institute at Virginia Oncology Associates, and Kyle Lavin, MD, MPH, UNC School of Medicine, University of North Carolina at Chapel Hill, discuss the findings of a study evaluating the integration of virtual collaborative behavioral health care for patients with breast cancer.

From the perspective of a practicing oncologist, the primary takeaway of this initiative is the necessity of treating the patient as a whole rather than focusing solely on the cancer or physical symptoms. A cancer diagnosis is inherently stressful, and a majority of patients face mental health challenges, such as adjustment disorders or other psychological issues, during their journey. Because of this, it is considered vital to integrate mental health solutions at a system level. These solutions must be designed to break down existing barriers and remain highly accessible to patients without creating an additional clinical burden for the oncology team.

Frictionless Integration into Oncology Workflows

One of the most promising aspects of the virtual collaborative care model is its "frictionless" integration. The researchers recognize that oncologists are already under immense pressure and maintain extremely busy schedules. This model is specifically designed to fit into existing oncology workflows, acknowledging that mental health and oncology needs are inseparable. By providing high-quality psychological care within the oncology framework, the model actually improves efficiency and preserves the oncologist's time rather than acting as an extra burden.

Financial Sustainability and the "Digital Front Door"

A long-term mission for the researchers has been to fundamentally change how individuals living with serious illnesses access supportive care. A major development in this area is the implementation of fee-for-service codes that allow the virtual collaborative care model to be reimbursable. This financial structure ensures that the program is not only accessible to patients but also profitable for the practices that implement it. Moving forward, the goal is to expand this model to all cancer patients, effectively serving as a "digital front door" where every new diagnosis is met with immediate access to integrated support.

Scaling and Clinical Trial Integration

The researchers are focused on the future implementation and scaling of this model across diverse environments, including community oncology practices and academic medical centers with varying resource levels. The objective is to create a stepwise model that reduces waiting times and ensures every patient receives the right care at the right time, rather than relying on siloed programs. Additionally, there is a strong desire to see these mental health interventions integrated into clinical trials. As mental health is a critical factor in treatment adherence and patient retention within studies, researchers believe it is essential to study how integrated psychological care affects general oncology outcomes.