Closing the depression gap in community oncology: Real-world outcomes from collaborative care.

Abstract

12088 Background: Depression is prevalent among patients with cancer, yet access to evidence-based care remains uneven. Community oncology clinics, where the majority of cancer care occurs, are less likely to offer integrated mental health services compared to comprehensive cancer centers, resulting in higher underdiagnosis, undertreatment, and persistent depressive symptoms. The Collaborative Care Model (CoCM) offers a potential strategy to address this disparity in community oncology. Methods: Community oncology patients with clinically significant symptoms of depression, as measured by a baseline PHQ-9 score ≥ 5, and receiving collaborative care, delivered primarily remotely, for at least 80 days were analyzed as part of this observational study. Patients had their PHQ-9 assessed after 90 (≥ 80 & ≤ 100) days, including evidence of remission (PHQ-9 < 5) and signs of response (decrease of PHQ-9 score by ≥ 50% or ≥ 5 points). Mean within-patient changes among all patients, stratified by baseline depression severity, were measured using paired t-tests. Results: Among 307 patients, mean PHQ-9 scores were observed to decline from 12.9 (SD 4.7) at baseline to 8.2 (SD 5.1) after 90 days of collaborative care (mean change -4.72, 95% CI -5.30 to -4.14, P< 0.001); 26.7% were observed to have depressive symptoms in remission and 51.5% had a clinical response. Patients with severe depression (PHQ-9 >=20) at baseline had the largest improvement (mean change -9.60, 95% CI -11.78 to -7.42, P < 0.001). Conclusions: Community oncology patients with depressive symptoms receiving collaborative care experienced reductions in PHQ-9 scores after 90 days of care, with a substantial proportion experiencing clinical response and/or remission in this brief timeframe. Symptom changes were observed across the full spectrum of symptom severity. These real-world outcomes highlight meaningful decreases in depressive symptoms, underscoring the promise of CoCM as a scalable care model for community oncology clinics. Observed depression outcomes among community oncology patients engaged in Collaborative Care Model (CoCM) psychosocial care for 90 days, stratified by baseline PHQ-9 severity. PHQ-9 Score Category at Baseline N Mean PHQ-9 Score at Baseline (SD) Mean PHQ-9 Score at 90 Days (SD) N Observed in Remission at 90 Days (%) N Experiencing Response at 90 Days (%) Mean Total PHQ-9 Score Change(95% CI) All (5–27) 307 12.9 (4.7) 8.2 (5.1) 82 (26.7) 158 (51.5) -4.72*** (-5.30, -4.14) Mild (5-9) 81 7.2 (1.4) 5.4 (3.6) 36 (44.4) 26 (32.1) -1.86*** (-2.64, -1.08) Moderate (10-14) 113 11.9 (1.4) 7.8 (4.2) 28 (24.8) 55 (48.7) -4.08*** (-4.85, -3.31) Moderately Severe (15-19) 83 16.5 (1.4) 9.9 (5.5) 15 (18.1) 55 (66.3) -6.61*** (-7.85, -5.38) Severe (20-27) 30 21.9 (1.6) 12.3 (6.0) <11 22 (73.3) -9.60*** (-11.78, -7.42) ***P<0.001.