A Kaiser Permanente study shows a well-designed screening program for patients with breast cancer increased assessments for depression and referrals for appropriate care
BY DR. TATJANA KOLEVSKA
THE IMPACT OF BREAST CANCER
Approximately 1 in 8 American women will develop breast cancer during their lifetimes. In 2021, the American Cancer Society, estimated 281,550 new cases of invasive breast cancer were expected to be diagnosed in women in the
U.S., along with 49,290 new cases of non-invasive (in situ) breast cancer according to 2019-2020 Breast Cancer Facts & Figures (https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf).
Getting a mammogram is the most effective way to detect breast cancer early, when the odds of survival are highest. Kaiser Permanente performs more than 1 million mammograms every year. Breast cancer is also an active area of study for Kaiser Permanente Research. Scientists across the organization have used rich, comprehensive, longitudinal data to advance knowledge in the areas of understanding risk, improving patient outcomes and translating research findings into policy and practice.
APPROACH TO CARE IS MORE THAN PHYSICAL
“Early identification and treatment for mental health issues is critical, yet depression and other mental health issues are often underidentified and undertreated in breast cancer patients,” said the study’s lead author, Erin E. Hahn, PhD, a research scientist with Kaiser Permanente Southern California Department of Research & Evaluation. “Our study showed that the use of implementation strategies to facilitate depression screening is highly effective and provided insights into how to create a sustainable program to help our cancer patients achieve the best possible health.”
UNDERSTANDING DISTRESS DURING DIAGNOSIS
It has been difficult historically to incorporate mental distress screening during cancer care when patients tend to be vulnerable to mental health challenges. Researchers from Kaiser Permanente in Southern California set out to determine if a process of incorporating depression screening into routine clinical care with support from researchers might make a difference.
They separated medical oncology teams at different locations into two groups. In the first group, physicians and nurses received education about depression screening, regular feedback on their performance, and support in determining the best ways to add depression screening into their current workflow. In the second group — the control group — physicians and nurses received only education. Screening was conducted using the Patient Health Questionnaire 9-item version, known as the PHQ-9.
All patients diagnosed with new breast cancers who had a consultation with medical oncology between October 1, 2017, and September 30, 2018, were included in the study. Researchers enrolled 1,436 members: 692 in the control group and 744 in the intervention group. The groups were similar in demographic and cancer characteristics.
● 80% of patients in the intervention group completed depression screening versus less than 1% in the control group.
● Of intervention group screenings, 10% scored in the range indicating need for referral to mental health services. Of those, 94% received referrals.
● Of those referred, 75% completed a visit with a mental health provider.
● Additionally, patients in the intervention group had significantly fewer clinic visits to the oncology departments, and no difference in outpatient visits for primary care, urgent care, and emergency department services.
“The trial of this program was so successful that, with funding from our Care Improvement Research Team, we have rolled out depression screening initiatives across all our Kaiser Permanente medical oncology departments in Southern California,” said Hahn. “We are incorporating the lessons learned from the trial, particularly the importance of ongoing audit and feedback of performance, and are encouraging our clinical teams to adapt the workflow to meet their needs.”
5 THINGS TO CONSIDER WHEN CHOOSING HEALTH COVERAGE FOR CANCER CARE
1. Personalized cancer care that starts with prevention and early detection
2. Multidisciplinary teams, supported by telemedicine expert consultation
3. Virtual navigation and psychosocial support with guided meditations in digital resources
4. Shared Electronic Medical Record (EMR) where doctors, hospitals, and health plan work together
5. Access to clinical trials encouraging our clinical teams to adapt the workflow to meet their needs.”
PATIENT-FOCUSED TEAM DURING CHALLENGING TIMES
Kaiser Permanente provides treatment to over 500,000 cancer patients each year. (“Destination Health: Stopping Cancer Before It Starts,” Permanente.org, January 21, 2020 – https://about.kaiserpermanente.org/our-story/our-care/destination-health-stopping-cancer-before-it-starts). Within the fully integrated care and coverage model research scientists, clinicians, medical groups, and health plan leaders collaborate — this environment is unique and allows teams to contribute important knowledge about breast cancer, and many other topics of research with the larger community.
As one of the nation’s most productive research institutions, Kaiser Permanente is transforming the future of health and healthcare. Researchers use their deep expertise, strategic partnerships, and the rich resource provided by electronic health record system to conduct groundbreaking research that translates into benefits for individual patients, health care delivery systems, and society at large.
To learn more about Kaiser Permanente’s approach and innovations in cancer care, and educate your clients, visit kp.org/choosebetter and contact your Kaiser Permanente account representative.
ABOUT KAISER PERMANENTE
Kaiser Permanente is committed to helping shape the future of healthcare. Recognized as one of America’s leading health care providers and not-for-profit health plans. Kaiser Permanente is dedicated to care, innovations, clinical research, health education, and the support of community health.
DR. TATJANA KOLEVSKA is the medical director of the Kaiser Permanente National Cancer Excellence Program overseeing cancer care for more than 12 million members across eight Kaiser Permanente regions.
She is also the chair of the Kaiser Permanente Northern California Oncology, Hematology and Infusion Centers. Additionally, Dr. Kolevska is the chair of Kaiser Permanente Northern California Physician Education and CME Program leading education for more than 10 000 physicians. She co-directs the Kaiser Permanente Northern California Oncology Clinical Trials Program, overseeing clinical research for 150 cancer experts.
In her role she organizes and leads cancer prevention, diagnosis and treatment strategies harnessing the advantages of the integrated, national Kaiser Permanente healthcare system.
Dr. Kolevska completed a hematology and oncology fellowship at Columbia University in New York. She received an MD degree and Master of Science in Clinical Immunology and Allergy at the University of Zagreb, School of Medicine.