How Virtual Collaborative Care Is Transforming Mental Health in Oncology

In the high-stakes environment of community oncology, the focus is often, understandably, on the biology of the tumor. However, a growing body of evidence suggests that treating the cancer without treating the whole person is an incomplete strategy.

In an interview with Targeted Oncology, Nina Balanchivadze, MD, FACP, a medical oncologist at Virginia Oncology Associates, and Kyle Lavin, MD, MPH, a palliative care psychiatrist at the University of North Carolina at Chapel Hill and cofounder of Cerula Care, shed light on how a virtual collaborative care model is bridging the gap between physical and mental health.

The Follow-Through Problem

For Balanchivadze, the need for integrated mental health support is not a matter of theory but a daily clinical reality. "In community oncology, we routinely see depression and anxiety affect patients' ability to show up for care, adhere to treatment regimens, and cope with major transitions," she said. Although the medical team easily recognizes these struggles, the system often fails at the point of action.

"Recognition is really not a problem because we see this every day, but the actual follow-through is the problem because the next step when we identify a mental health issue is making an outside referral...and a lot of the patients, very frequently, do not have the access or cannot access those health systems in a timely way,” she added.

Lavin’s perspective is shaped by 20 years of professional and personal experience, including watching his own mother navigate comorbid mental and physical health concerns. He points out that the traditional "siloed" approach—where behavioral health is a separate, stand-alone program—rarely meets the patient's needs at the right time.

Measuring the Impact

To address these silos, they evaluated a virtual collaborative care model integrated alongside the oncologist team. This model consisted of a psycho-oncologist MD, a certified coach and case manager, and a behavioral health case manager. The study population of 207 patients with breast cancer was 99% women (mean age, 55.7 years), 58% White, 32.4% Black, and 83% non-Medicaid.

The results of their retrospective analysis were striking. The study didn’t just show vague improvements; it demonstrated clinically meaningful and statistically significant changes in mental health and quality of life over a 5-month period.

Key Clinical Statistics:

• Depression (Patient Health Questionnaire-9): Scores decreased by 6.63 points by month 5.
• Anxiety (General Anxiety Disorder-7): Scores improved with a decrease of 4.83 points by month 5.
• Quality of life (Functional Assessment of Cancer Therapy, General-7): Scores increased 1.58 points over 2 months.
• Operational success: Seventy percent of surveyed patients reported improved ability to keep their oncology appointments, and 65% reported better adherence to nonchemotherapy medications.

Lavin noted he was pleasantly surprised by the magnitude of the results. "Given how many nonmodifiable aspects there are to the cancer experience, I was a little bit worried that the amount of improvement that we would see wouldn't be as large as it was," he said.

Closing the Equity Gap

One of the most compelling findings of the research was what Balanchivadze called an "equity signal." The virtual nature of the model appears to dismantle traditional barriers to care that disproportionately affect minority and Medicaid populations.

"We've also observed that larger gains in quality-of-life scores were found among Black patients compared [with] White patients," Balanchivadze said. "Even though this finding is exploratory, it suggests that maybe this virtual integrated model could reduce access barriers that disproportionately affect historically underserved patients." By providing specialized psycho-oncology support virtually, the model brings academic-level expertise to community settings where such specialists are often hard to access or nonexistent.

A "Frictionless" Future for Oncologists

Crucially, this model is designed to support the medical team as much as the patient. Lavin emphasized that the collaborative care model is meant to be "frictionless," recognizing the intense pressure on oncologists.

"This is a way to provide high-quality care that allows the oncologist to address the mental health needs but not take away from the ability to address the oncology need.... It actually makes them more efficient and able to have more time rather than providing extra burden."

Looking ahead, both doctors see this as the "digital front door" for cancer care. Lavin noted that new fee-for-service codes make the model reimbursable and sustainable for practices. Meanwhile, Balanchivadze, as a clinical researcher, advocates for this model to be integrated into randomized clinical trials to see how mental health support directly influences general oncology outcomes and treatment adherence.

"We don't only treat our patients' cancer. We don't just treat physical symptoms. We treat patients as a whole,” Balanchivadze said.

REFERENCE

Balanchivadze N, et al. Integrating virtual collaborative care behavioral health in breast cancer care: improving outcomes in mental health, adherence, and racial equity. Presented at: 2025 San Antonio Breast Cancer Symposium; December 9-12, 2025; San Antonio, TX. Abstract PS5-10-27.