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Telephone-based intervention improved pain, depression in patients with cancer
Kroenke K. JAMA. 2010;304:163-171.
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Significant improvements were observed in pain and depression among patients with cancer who participated in a centralized, telephone-based care management system in combination with a home-based, automated, symptom monitoring system — the findings did not appear to be confounded by differential rates of co-interventions or health care use, according to the researchers.
Despite being two of the most common and treatable cancer-related symptoms, pain and depression are far too often undiagnosed and undertreated. Researchers for the Indiana Cancer Pain and Depression trial assessed a collaborative care approach system to managing depression and pain in patients at 16 community-based urban and rural oncology practices in Indiana.
Patients were randomly assigned to an intervention (n=202) or usual care group (n=203) and were further grouped by symptom type. The intervention group consisted of centralized, telephone-base care management by a nurse-physician team combined with automated home-based symptom monitoring by interactive voice recording or Internet. The primary outcome measure was blinded assessment for severity of depression and pain at baseline and at months 1, 3, 6 and 12.
Overall, 131 patients had depression; 96 had pain; and 178 had both depression and pain.
Compared with patients in the usual-care group with pain (n=137), patients in the intervention group with pain (n=137) showed greater improvements in pain severity at 12 months as measured by Brief Pain Inventory (>30% decrease).
In addition, compared with patients in the usual-care group with depression (n=155), patients in the intervention group with depression (n=154) showed significantly greater improvements in depression severity as measured by the Hopkins Symptom Checklist (>50% decrease).
The researchers also assessed between-group differences in secondary outcome measures. At 3 and 12 months, the standardized effect size was 0.67 (95% CI, 0.33-1.02) and 0.39 (95% CI, 0.01-0.77) for pain, and 0.42 (95% CI, 0.16-0.69) and 0.41 (95% CI, 0.08-0.72) for depression, respectively. Further, patients in the intervention group showed greater improvements in other health-related quality-of-life areas, such as mental health, anxiety, vitality and physical symptom burden.
“The fact that [the trial] was beneficial for the most common physical and psychological symptoms in cancer patients demonstrates that a collaborative care intervention can cover several conditions, both physical and psychological,” the researchers wrote.
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