CanDirect: Effectiveness of a Telephone-Supported Depression Self-Care Intervention for Cancer Survivors

Abstract

PURPOSE Depression in post-treatment cancer survivors is common and can impair quality of life. CanDirect is a novel, telephone-delivered depression self-care intervention for cancer survivors. We conducted a randomized controlled superiority trial to compare CanDirect with usual care (UC) in this population. METHODS Participants completing cancer treatment within the past 10 years who had mild-moderate depressive symptoms with or without major depression were recruited from clinical and community settings in Quebec and Ontario. Permuted block random assignment allocated participants to CanDirect plus UC or to UC alone. Assessments of depression severity (Center for Epidemiological Studies-Depression scale [CES-D]; primary outcome) and secondary outcomes health-related quality of life (Short Form Survey-12 mental and physical component summaries), anxiety symptoms (Hospital Anxiety and Depression Scale), activation (Patient Activation Measure), depression diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV), and health services (self-report) were conducted at baseline, as well as 3 and 6 months (primary time point). Analyses of outcomes were adjusted for covariates using linear regression and missing data by inverse probability weighting. RESULTS Participants recruited between September 2016 and October 2018 were randomly assigned to CanDirect (n = 121) or UC (n = 124). Among 245 participants randomly assigned, 218 (89.0%) completed the primary outcome at 6 months. CanDirect participants reported less severe depressive symptoms on the CES-D than UC participants at 6 months, adjusted effect size (ES) 0.61 (95% CI, 0.33 to 0.88). CanDirect participants also had significantly greater quality of life, lower anxiety, more activation, and lower rates of depression diagnoses, compared with UC. Exploratory analysis suggested that sex was a modifier of the primary outcome (interaction term P value = .03); the intervention was less effective in men (ES, 0.12; 95% CI, −0.45 to 0.69). CONCLUSION The findings suggest that CanDirect is an effective method of managing mild-moderate depression symptoms in cancer survivors.

Trained lay coaches and self-care cognitive-behavioral tools improve depression outcomes

“…Coaching was delivered in short telephone calls, using standardized protocols. The results of this research indicated beneficial effects of the coached interventions in different target populations on depression at 6 months: adjusted effect sizes were 0.42 (95% CI 0.08, 0.77) for a coached vs self-guided intervention among patients with chronic physical conditions not receiving therapy at study entry [9], and 0.60 (95% CI 0.33, 0.87) for a coached intervention vs usual care among cancer survivors [10]. These effect sizes are consistent with those reported in meta-analyses [5,6,11].…”

“…Despite the evidence of effectiveness of the intervention among cancer survivors [10], the lack of associations between adherence and outcomes in the cancer survivor cohort is perplexing.…”

“…• Study 3 [10] : RCT of CanDIRECT in cancer survivors: intervention group was coached self-care (cohort 4) versus usual care controls (cohort 5). Note that cohort 5 was included for comparative purposes; it was not included in the adherence analysis, as no intervention was provided.…”

“…In cohort 1, patients receiving counseling at least once a month were excluded. Methodological details of these studies can be found in the primary publications [7,8,10].…”

“…To address this limitation and to increase patient autonomy, we developed an innovative depression self-care intervention, delivered by trained lay coaches. We evaluated the intervention in several trials for depression in different target populations [7][8][9][10]. The intervention comprises a toolkit of core self-care tools based on CBT principles, supplementary relaxation tools, and informational tools on healthy lifestyle adapted to the needs of the target populations.…”