BRIDGE: A randomized trial of person-centered collaborative care for adults with serious mental illness (SMI) and newly diagnosed cancers.

Abstract

216 Background: Individuals with SMI experience increased cancer mortality due to inequities in cancer care. Proactive psychiatry care may improve cancer care outcomes for patients with SMI, yet access to mental health care remains inadequate. The BRIDGE trial assessed the impact of person-centered collaborative care vs enhanced usual care (EUC) on cancer care disruptions for adults with SMI and newly diagnosed cancers. Methods: Eligible patients had SMI (schizophrenia spectrum, bipolar, or severe major depressive disorders) and potentially curable head/neck, lung, breast, or gastrointestinal cancers. Patients were randomized 1:1 to BRIDGE (person-centered collaborative care: proactive psychiatry consultation, linkage to a social work/navigator team, and co-management with oncology across care settings) or EUC (proactive identification at cancer diagnosis using an algorithm to inform the oncology team of the SMI diagnosis and patient of psychosocial resources). The primary outcome was clinically significant cancer care disruptions over 24 weeks (delays in treatment initiation, deviations from guideline-concordant care recommended/received, or interruptions in planned cancer treatment). Oncologists blinded to intervention arm determined the presence of disruptions (yes/no) using NCCN guidelines; discrepancies were resolved by a consensus panel. Secondary outcomes included psychiatric illness severity according to the Brief Psychiatric Rating Scale (BPRS), Clinical Global Severity (CGI), and depression/anxiety measures (Patient Health Questionnaire [PHQ] 9, Generalized Anxiety [GAD] 7) at 24 weeks. The rate of disruption was compared using Fisher’s exact test, and secondary outcomes were compared using ANCOVA and logistic regression. Results: From May 2019-December 2021,120 of 141 eligible patients enrolled in the trial. Participants had a mean age of 63 years, were 65% female, 87.5% reported White race, 52.5% had income <25,000, 51.7% had Medicaid, 38.3% were on disability, 39.4% reported current smoking, and 49% reported past/current substance use disorder. Patients assigned to BRIDGE were significantly less likely to experience cancer care disruptions compared to those receiving EUC (17.2% vs 35.1%, p=.035). BRIDGE patients had significantly improved psychiatric illness severity and anxiety (BPRS: 31.91 vs 36.65, p=.02; CGI: 15% vs 25%, p=.02; GAD: 4.86 vs 6.86, p=.02) compared to EUC patients. Differences in PHQ were not significant (6.62 vs 7.72, p=.28). Conclusions: In this randomized trial of person-centered collaborative care for adults with SMI and cancer, the BRIDGE intervention led to significantly fewer disruptions in cancer care and improvement in psychiatric illness severity. Findings support the need for multi-site trials that include community settings to enhance generalizability. Clinical trial information: NCT03360695 .