Effect of Telecare Management on Pain and Depression in Patients With Cancer

Abstract

Context Pain and depression are two of the most prevalent and treatable cancer-related symptoms, yet frequently go unrecognized and/or undertreated. Objective To determine whether centralized telephone-based care management coupled with automated symptom monitoring can improve depression and pain in cancer patients. Design, Setting, and Patients Randomized controlled trial conducted in 16 community-based urban and rural oncology practices across the state of Indiana. Recruitment occurred from March 2006 through August 2008 and follow-up concluded in August 2009. The 405 patients had depression (Patient Health Questionnaire-9 score ≥ 10), cancer-related pain (Brief Pain Inventory worst pain score ≥ 6), or both. Intervention Patients were randomly assigned to the intervention (n=202) or to usual care (n=203), stratified by symptom type. Intervention patients received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or internet. Main Outcome Measures Blinded assessment at baseline, 1, 3, 6, and 12 months for depression (20-item Hopkins Symptom Checklist [HSCL-20]) and pain (Brief Pain Inventory [BPI]) severity. Results There were 131 patients enrolled with depression only, 96 with pain only, and 178 with both depression and pain. Of the 274 patients enrolled for pain, the 137 intervention patients had greater improvements than the 137 usual care patients in BPI pain severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical pain responder (P < .0001 for both). Similarly, of the 309 patients enrolled for depression, the 154 intervention patients had greater improvements than the 155 usual care patients in HSCL-20 depression severity over the 12 months of the trial whether measured as a continuous severity score (P < .0001) or as a categorical depression responder (P < .001). The standardized effect size for between-group differences at 3 and 12 months was .67 and .39 for pain, and .42 and .44 for depression. Conclusion Centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients receiving care in geographically-dispersed urban and rural oncology practices.

Effects of screening for psychological distress on patient outcomes in cancer: A systematic review

“…Three other smaller trials [34,43,47] reported somewhat larger effects for fluoxetine (Hedges's g = 0.36) [43] and mianserin (Hedges's g = 0.60 to 0.77) [34,47]. Among collaborative care trials, effect sizes were small to moderate for adequately powered trials (Hedges's g = 0.17 to 0.47) [35,37,40,44] and moderate to large for a smaller study (Hedges's g = 0.60) [46]. The effect sizes for outcomes reported in a trial of problem-solving therapy trial [42], comparing problem-solving therapy to a wait-list control (Hedges's g = 3.76) or problem-solving therapy with a significant other to the wait-list control (Hedges's g = 4.30) were exceedingly large.…”

“…As shown in Table 1, the 14 studies of interventions to reduce psychological distress we reviewed included 12 studies of patients with mixed cancer sites [34][35][36][37][38][39][40][41][42][43][44][45], 1 study with patients with breast or cervical cancer [46], and 1 study with patients with breast cancer only [47]. Total sample size per study ranged from 55 to 472.…”

“…Total sample size per study ranged from 55 to 472. Of the 14 studies, 7 randomized at least 64 patients per group [35,[37][38][39][40]44,45], which would provide adequate (80%) power to detect a medium effect size (standardized mean difference = 0.50) [48].…”

“…The other 10 studies included collaborative care interventions [35,37,40,44,46], cognitive behavior therapy [36,39,41], problem solving therapy [42], and aromatherapy massage [45]. Among the drug trials, there was 1 study [38] with at least 64 patients per group, and that study found a small effect size reduction on self-reported depressive symptoms with fluoxetine (Hedges's g = 0.23).…”

Tele-asistencia y tele-alarma para adultos mayores: experiencias preliminares en Mexico

“…Tele-care was shown to influence improvements in levels of depression, 4 in quality of life, 5 decreasing visits to the emergency room and greater adherence to medical recommendations, 1 support in the case of falls, giving a feeling of security and reduction in anxiety, 2 the perception of more independent life and, with relation to the caregiver/relative, more free time, peace of mind and security. 5 Give the effects that the tele-care program had, the majority recommended the use of these services.…”