Dana-Farber's New Model Emphasizes the Vital Link Between Mental and Physical Health for Those Facing Cancer
March 3, 2025
By Kara Baskin
A lump felt in the shower. Weight loss. Night sweats. The anticipation — refreshing the portal for results, awaiting a phone call, wondering if your life will change in an instant.
A cancer diagnosis can trigger anxiety, depression, even existential distress. But treatment is often initially geared to physical symptoms, such as chemotherapy and radiation. At Dana-Farber, mental health care receives equal attention. Now, through a new Supportive Oncology Collaborative, that care will be more fully integrated into the patient experience.
Drawing from Dana-Farber's long tradition of psychosocial oncology, the Supportive Oncology Collaborative is a model designed to improve access to supportive care for cancer patients, particularly those in underserved populations. It integrates various disciplines, including social work, psychiatry, psychology, and palliative care, into a cohesive team that coordinates to meet cancer patients' unique mental and physical needs. Instead of seeing many different providers at various offices, care is streamlined through an oncology social worker and assessed at weekly cross-disciplinary meetings.
"It's a fitting innovation for an institution that hired the first oncology social worker back in the 1950s, through Dana-Farber founder Sidney Farber," says James A. Tulsky, MD, chair of Supportive Oncology.
Streamlined Care at an Uncertain Time
The nascent program started at Dana-Farber's regional campuses. This year, it will begin its debut at each of Boston's treatment centers, beginning with sarcoma and neuro-oncology.
Oncology social workers lead initial intake assessments and act as care leads, using validated mental health assessment tools to provide insights into each patient's psychological and emotional state. The social worker acts as a care champion, who then presents each patient's case to the full supportive oncology team, which meets weekly to steer holistic care.
"We're consulting to make sure that we're providing the best services for patients and families," says Courtney Bitz, senior director of social work at Dana-Farber. "In some care models, you might have to see a psychiatrist, then you have to go a social worker, and they're not talking to each other. We're very much integrated into medical care. It's very unique to Dana-Farber."
The fact that social work is so integrated into our care is one of the things that makes Dana-Farber special. These different specialties and disciplines live within one department, and we have premier clinicians and scientists in each one. The level of skill here is pretty extraordinary, including more than 50 academic faculty.
Bridging Mental and Physical Health
Providers address a suite of cancer-related concerns, from treatments for needle-phobia and "scanxiety" to broader questions about mortality and legacy. The Supportive Oncology department also runs a robust research program exploring promising interventions to enhance quality of life, and the Supportive Oncology Collaborative helps to direct patients to appropriate trials.
"The fact that social work is so integrated into our care is one of the things that makes Dana-Farber special," Tulsky says." These different specialties and disciplines live within one department, and we have premier clinicians and scientists in each one. The level of skill here is pretty extraordinary, including more than 50 academic faculty."
The program is robust, but the term "supportive oncology" is often foreign to new patients who associate cancer care with radiation and chemotherapy — but who are reassured to find mental health support, too.
"Supportive oncology focuses on quality of life: living as well as possible while you have cancer," Tulsky says. "We attend to all of the physical and emotional symptoms that might arise when experiencing cancer's effects and treatments."
In addition to mental health care, the department includes devoted palliative care pharmacists with expertise in medication and pain management, including the use of opioids and their addictive potential. Meanwhile, palliative care specialists help patients navigate care decisions regarding prognosis, treatment — including clinical trials — and outcomes.
"We're trained in serious illness conversations, where we try to assess patients' understanding of their illness, explore prognostic awareness, and try to identify what is most important to them — their hopes, their worries — and then help them make treatment choices that reflect their values," Tulsky explains.
Support Tailored to Cancer's Unique Challenges
To that end, mental health care for cancer patients is specialized. In addition to mortality fears, many patients experience shame or self-doubt for having mental health concerns in the first place, worrying that they're not fighting hard enough. This program mitigates those doubts.
"When you have cancer, you can have concerns about: 'Am I somehow failing and not being a good patient or a fighter?" explains William Pirl, MD, MPH, vice chair of the supportive oncology program.
These feelings can impede successful treatment, Pirl says. Patients struggling with mental health have trouble drawing on community support, keeping appointments, or adhering to treatment plans.
"The goal of our services is to help people through their cancer treatment so they can have the best medical and functional outcomes," Pirl says. "There's evidence that depression and stress are associated with worse cancer outcomes."
While Pirl won't draw a direct connection between mental health treatment and improved cancer outcomes, he says one thing is clear.
"If people treat their depression and anxiety, they're able to engage more in their cancer treatment," Pirl says. "They're able to go to appointments. They're able to be more physically active. They're also able to stay more connected to their family and social support, and those things are key for getting people through tough times. Treatment allows people to function better so they're able to do those things that we know lead to better cancer outcomes."
With the new collaborative care model, better outcomes are in closer reach especially for patients who are already overscheduled, overwhelmed, and preoccupied. While patients across age groups benefit from supportive oncology, busy young adult patients — often caring for young kids, elderly parents, and at the peak of their careers — particularly benefit from streamlined care.
"You might be part of the sandwich generation, where you're taking care of kids and elderly parents," says Cristina Pozo-Kaderman, PhD, a psychologist who directs Dana-Farber's Young Adult Program. "The focus is on other people's health and not your own, and then that focus is interrupted. There's a sense of isolation; you're out of sync with your peers. It disrupts the order of things."
Heather McCready, 42, is one such patient. A self-described worrier even before cancer, McCready was monitored closely for breast cancer due to an abnormal mammogram. She was referred to Dana-Farber, where she was diagnosed with atypical cells that required ongoing surveillance, including an annual MRI. However, after a clear mammogram and an ultrasound, she checked breast cancer off her list of concerns and focused on her career and young family. But in summer 2024, she felt a hardening in her right breast. Another mammogram and ultrasound were clear.
Patient Heather McCready (left) and Kathryn Rigby of the Department of Supportive Oncology
"We moved up the MRI, and under dense tissue, they found a six-centimeter sheet of cancer and an enlarged lymph node," McCready recalls. "When I got the phone call confirming I had cancer, those words split your life: Before, it was steady, focused on my family and my career. Now, I had cancer. Instantly, nothing was certain anymore. It wasn't just my life that flashed before my eyes. It was my kids' lives, and the utter desperation to see them grow up."
In addition to undergoing a double mastectomy and chemotherapy, McCready now receives social work support as she navigates future treatment. At appointments, she completes evaluations pertinent to her diagnosis with questions about physical comfort as well as body image, self-esteem, and anxiety levels. "It's remarkable to me that there's this consideration and concern," she says.
McCready is also part of a support group through Dana-Farber's Young and Strong Program, comprising younger adults, many with children, like herself. "Instantly, I felt less alone. Just knowing the group exists gave me so much perspective and comfort," she says. Early on, McCready was also paired with a patient with a similar diagnosis and treatment plan to discuss her surgery experience. This peer-to-peer mentorship was potent.
"She was able to give me the down-and-dirty details of her experience, and it made me feel confident that a double mastectomy was the right path for me," McCready says.
McCready is currently undergoing radiation therapy as well as endocrine therapy, followed by breast reconstruction — a trajectory that feels less daunting thanks to relatable peers.
McCready's experience mirrors that of so many cancer patients: blindsided by a devastating diagnosis in the prime of life. Not only is cancer frightening, but providers explain that there's a certain injustice — a "why me?" component that adds a layer of complexity for this specific population, making mental health care essential.
Pozo-Kaderman oversees virtual and in-person support groups dedicated to patients like McCready, from 18 until their early 40s; patients also can meet in a dedicated young adult lounge while at Dana-Farber.
"Many of our young adults will say, 'Wow, I can't believe I'm seeing someone my age,'" Pozo-Kaderman says. "Having that unity is pretty major."
Balancing Strength and Vulnerability in Cancer Care
Many young adult patients also grapple with concerns about toughness and resilience. They're ashamed of their feelings; they worry that they're not fighting hard enough for their kids if they succumb to emotions. The supportive oncology team assures patients that these reactions are normal but also don't have to derail their physical treatment.
"Cancer can hijack your whole life," says Michelle Jacobo, PhD, director of Psychology Services at Dana-Farber. "It is an assault to our psyche. Some people feel like, 'If I cry, then I'm not going to be fighting the good fight,' and we try to make sure people understand that we're complicated humans. You can be a profound warrior against cancer and also be a mess and cry."
This was true for ovarian cancer patient Christine, diagnosed at age 47. An unflappable psychiatric nurse and mom of three, she ignored telltale symptoms, such as back pain and bloating, until a CT scan revealed a large ovarian tumor. She was busy and athletic; she didn't see herself as a cancer patient — until she had no choice. After her stage 3 diagnosis, well-meaning friends and family tried to help by encouraging her to eat more, when what she really needed was a support system of peers who understood.
"Now I say to people: 'Do not be shy about asking for help,'" Christine says. "Cancer is about more than just getting chemo. It's really important to talk it through with people who understand your fears and your hopes, with no judgment."
At Dana-Farber, clinicians aim to destigmatize mental health care for people like Christine: It's possible to fight hard physically while also letting down one's guard mentally, even if it's never been your style.
When you get a cancer diagnosis, the coping mechanisms you've used all your life may not work during this time. It can be very helpful to have somebody there to support you in navigating the different stressors that a cancer diagnosis can bring.
"When you get a cancer diagnosis, the coping mechanisms you've used all your life may not work during this time," Bitz says. "It can be very helpful to have somebody there to support you in navigating the different stressors that a cancer diagnosis can bring."
Jaime Keating, 52, a breast cancer survivor with brain metastasis, wants to share that message. Outspoken and confident, she hopes to spread awareness about the paradox of emotion and toughness, and she sees Dana-Farber's programs as crucial to that mission. She has received social work and group survivor support for both breast and brain cancers, making a point to share her diagnosis story — while refusing to be defined by cancer. She wants other patients to know that psychosocial oncology is as life-sustaining as any other cancer treatment, no stigma attached.
"There needs to be a shift in the dialogue around cancer," Keating says. "Dana-Farber's social worker network has become a lifeline for stabilizing my life. Through the supportive oncology program and the work we've done, I'm saying 'I am still Jaime; I still have a purpose.'"