Candidate: This K08 Career Development Award will prepare Dr. Irwin to become an independent R01-level investigator in cancer care delivery for patients with serious mental illness (SMI), with a focus on developing and scaling interventions to improve cancer outcomes for this vulnerable population. She will gain expertise in the design, execution, and analysis of randomized controlled trials, mixed methods, and implementation science. Dr. Irwin?s work will position her to contribute to national efforts to integrate psychosocial care into cancer care delivery and decrease disparities in cancer mortality for a neglected population. Environment: The Massachusetts General Hospital (MGH) Department of Psychiatry, the MGH Cancer Center, and Harvard Medical School will provide institutional support. Mentorship: Mentors are internationally-recognized investigators with complementary expertise: pragmatic trials for SMI (primary mentor: Andrew Nierenberg, MD), mixed methods and implementation science (co-mentor: Elyse Park, PhD, MPH), and supportive oncology interventions (co-mentor: Jennifer Temel, MD). Dr. Irwin will receive invaluable guidance in designing, conducting, and analyzing a randomized controlled trial of a proactive psychiatry consultation intervention integrated into cancer care and gain critical knowledge about the hospital and community mental health system to inform implementation in the community. Drs. Nierenberg, Park, and Temel are committed to assisting Dr. Irwin in meeting her goals. Additional scientific advisors will provide expertise in: clinical informatics (Adrian Zai, MD PhD, MPH), analysis of claims data (Vicki Fung, PhD), iterative intervention development and longitudinal assessment (Joseph Greer, PhD), biostatistics (Yuchiao Chang, PhD), hospital administration and quality improvement (Inga Lennes, MD, MPH, MBA), and the public mental health system (Kathy Sanders, MD). Training: Dr. Irwin will complete her research project and structured training including: meetings with mentors and advisors, seminars, conferences, manuscript writing, an externship at the Department of Mental Health, and coursework at Harvard Catalyst, the Harvard School of Public Health, and the NIH (research ethics, mixed methods, longitudinal analysis, and implementation science). Research: Individuals with SMI experience inequities in cancer treatment that contribute to premature cancer mortality yet targeted interventions have not been designed to improve care for this underserved population. We propose a randomized controlled trial to 1) investigate the impact of proactive psychiatry consultation (PPC) on cancer care (disruptions and health care utilization), 2) investigate the impact on patient and caregiver-reported outcomes including psychiatric symptoms, engagement in care, and caregiver burden, and 3) identify barriers and facilitators to implementing and disseminating PPC in the cancer center and the community through qualitative interviews with stakeholders (clinicians, patients, caregivers). Next steps: Dr. Irwin will apply for R01 funding in Year 4 to test the effectiveness and implementation strategy of PPC in a multisite RCT.
Individuals with serious mental illness experience markedly increased cancer mortality due to inequities in cancer treatment. Psychiatric care at the time of cancer diagnosis may prevent disruptions in cancer care yet targeted interventions have not been developed or tested for this population. A collaborative care intervention combining proactive psychiatry consultation and case management has the potential to decrease disparities in cancer treatment and improve cancer outcomes in this underserved population.