Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation?

Abstract

Objective To examine whether the effects of a nurse navigator intervention for cancer vary with baseline depressive symptoms. Method Participants were enrolled in a randomized controlled trial of a nurse navigation intervention for patients newly diagnosed with lung, breast or colorectal cancer (N=251). This exploratory analysis used linear regression models to estimate the effect of a nurse navigator intervention on patient experience of care. Models estimated differential effects by including interactions between randomization group and baseline depressive symptoms. Baseline scores on the 9-item Patient Health Questionnaire (PHQ) were categorized into 3 groups: no depression (PHQ=0-4, N=138), mild symptoms of depression (PHQ=5-9, N=76); and moderate to severe symptoms (PHQ= 10 or greater, N=34). Patient experience outcomes were measured by subscales of the Patient Assessment of Chronic Illness Care (PACIC) and subscales from an adaptation of the Picker Institute's patient experience survey at 4-month follow-up. Results With the exception of the PACIC subscale of delivery system/ practice design, interaction terms between randomization group and PHQ-9 scores were not statistically significant. Conclusions The intervention was broadly useful; we found it was equally beneficial for both depressed patients and patients who were not significantly depressed in the first four months post-diagnosis. However, because of the small sample size we cannot conclude with certainty that patients with depressive symptoms did not differentially benefit from the intervention.

Fear of Progression in Outpatients With Chronic Myeloid Leukemia on Oral Tyrosine Kinase Inhibitors

“…Oncology nurse navigators may represent a model of comprehensive cancer care for a growing number of outpatients with CML. They have been shown to alleviate distress in other chronic and complex cancer settings (Ludman et al, 2015;McPhillips et al, 2015;Swanson & Koch, 2010). Nurse navigators can stay in close contact to outpatients with CML and regularly reevaluate distress.…”

Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews

“…Nurse practitioner's telephone‐based guidance and support to facilitate chemotherapy‐induced side effect management among patients with lung cancer did not reduce symptom burden or likelihood of anxiety or depression as expected (Traeger et al, ). The nurse navigators’ role has been promising, but not conclusive, in relation to a reduction of depressive symptoms among newly diagnosed patients with lung, breast or colorectal cancer (Ludman et al, ). Nurse navigator interventions have, however, improved physical and social functioning and patient satisfaction (Lee et al, ), but not quality of life (QoL) (Wagner et al, ).…”

The Case for Patient Navigation in Lung Cancer Screening in Vulnerable Populations: A Systematic Review

“…23 In contrast, another trial found no difference in depression scores between navigated and non-navigated patients. 46 Four RCTs found navigated patients and usual care patients had no significant differences in quality of life. 23,45,47,48 Conversely, vulnerable women with abnormal mammogram results reported lower levels of anxiety in the navigation group than in the usual care group.…”

“…39,58 Navigated patients do not report a difference in quality of life 23,47 or depression. 46 However, navigation reduces anxiety in vulnerable populations. 39…”