Abstract
Purpose
A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care.
Methods
Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention.
Results
At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference −1.23, 95 % CI −3.81––1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living.
Conclusion
A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.
Similar content being viewed by others
References
Holland J, Watson M, Dunn J (2011) The IPOS new international standard of quality cancer care: integrating the psychosocial domain into routine care. Psycho-Oncol 20:677–680
Kroenke K, Theobald D, Wu J, Loza JK, Carpenter JS, Tu W (2010) The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. J Pain Symptom Manag 40:327–341
Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J, McHugh G, Walker A, Sharpe (2008) Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet 372:40–48
Fann JR, Fan M-Y, Unuetzer J (2009) Improving primary care for older adults with cancer and depression. J Gen Intern Med 24:417–424
Ell K, Xie B, Quon B, Quinn DL, Dwight-Johnson M, Lee P-J (2008) Randomized controlled trail of collaborative care management of depression among low-income patients with cancer. J Clin Oncol 26:4488–4496
Rankin N, Barron JA, Lane LG, et al. (2011) Psychosocial oncology services in New South Wales. Aust Health Rev 35:156–163
Dilworth S, Higgins I, Parker V, Kelly B, Turner J (2014) Patient and health professionals’ perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review. Psycho-Oncol 23:601–614
Wu SM, Brothers BM, Farrar W, et al. (2014) Individual counseling is the preferred treatment for depression in breast cancer survivors. J Psychosoc Oncol 32:637–646
Griffith JL, Gaby L (2005) Brief psychotherapy at the bedside: countering demoralisation from medical illness. Psychosomatics 46:109–116
Butow P, Price M, Shaw JM, Turner J, Clayton J, Grimison P, Rankin N, Kirsten L (2015) Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psycho-Oncol 24:987–1001
Hussey MA, Hughes JP (2007) Design and analysis of stepped wedge cluster randomised trials. Contemp Clin Trials 28:182–191
Turner J, Kelly B, Clarke D, Yates P, Aranda S, Jolley D, Chambers S, Hargraves MFL (2011) A randomized trial of a psychosocial intervention for cancer patients integrated into routine care: the PROMPT study (promoting optimal outcomes in mood through tailored psychosocial therapies). BMC Cancer 11:48
Centre NBC, Initiative NCC (2003) Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, Camperdown
(2010) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) for Distress Management V.1.2011. © National Comprehensive Cancer Network, Inc.
Donovan KA, Grassi L, McGinty HL, Jacobsen PB (2014) Validation of the distress thermometer worldwide: state of the science. Psycho-Oncol 23:241–250
Dilworth S, Higgins I, Parker V, Kelly B, Turner J (2014) Examining clinical supervision as a mechanism for changes in practice: a research protocol. J Adv Nurs 70:421–430
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:362–370
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) Functional assessment of cancer therapy (FACT) scale: development and validation of the general measure. J Clin Oncol 11:570–579
The EuroQol Group (1990) EuroQol Group: EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208
Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The demoralization scale: a report of its development and preliminary validation. J Palliat Care 20:269–276
Bonevski B, Sanson-Fisher RW, Girgis A, Burton L, Cook P, Boyes A, and the Supportive Care Review Group (2000) Evaluation of an instrument to assess the needs of patients with cancer. Cancer 88:217–225
Cameron IM, Crawford JR, Lawton K, Reid IC (2008) Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract 58:32–36
Zabora J, Brintzenmhofeszoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncol 10:19–28
DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment. Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160:2101–2107
Hopko DR, Aremento MEA, Robertson SMC, Ryba MM, Carvalho JP, Colman LK, Mullane C, Gawrysiakl Bell J, McNulty JK, Lejuez CW (2011) Brief behavioural activiation and problem-solving therapy for depressed breast cancer patients: randomized trial. J Consult Clin Psychol 79:834–849
Sharpe M, Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, Weller D, Murray G for the SMaRT (Symptom Management Research Trials) Oncology-2 Team (2014) Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT oncology-2): a multicentre randomised controlled effectiveness trial. Lancet 384:1099–1108
Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, Weller D, Murray G, Sharpe M for the SMaRT (Symptom Management Research Trials) Oncology-3 Team (2014) Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol 15:1168–1176
Lovell K, Richards D (2000) Multiple access points and levels of entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behav Cogn Psychother 28:379–391
Willemse GR, Smit F, Cuijpers P, Tiemens BG (2004) Minimal-contact psychotherapy for sub-threshold depression in primary care. Br J Psychiatry 185:416–421
Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R (2013) Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol 31:782–793
Walker J, Sawhney A, Hansen CH, Ahmed S, Martin P, Symeonides S, Murray G, Sharpe M (2014) Treatment of depression in adults with cancer: a systematic review of randomized controlled trials. Psychol Med 44:897–907
Riblet N, Larson R, Watts BV, Hotlzheimer P (2014) Reevaluating the role of antidepressants in cancer-related depression: a systematic review and meta-analysis. Gen Hosp Psychiatry 36:466–473
Peveler R, Carson A, Rodin G (2002) Depression in medical patients. BMJ 325:149–152
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos (2005) Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 23:5520–5525
Wentlandt K, Burman D, Swami N, Hales S, Rydall A, Rodin G, Lo C, Zimmerman C (2012) Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers. Psycho-Oncol 21:868–876
Rodin G (2014) Effective treatment for depression in patients with cancer. Lancet 384:1076–1078
Johnsen TJ, Friborg O (2015) The effects of cognitive behaviour therapy as an anti-depressive is falling: a meta-analysis. Psychol Bull 141:747–768
Patel V, Chisholm D, Parikh R, et al. (2016) Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet 387:1672–1685
Turner J, Clavarino A, Butow P, Yates P, Hargraves M, Connors V, Hausmann S (2009) Enhancing the capacity of oncology nurses to provide supportive care for parents with advanced cancer: evaluation of an educational intervention. Eur J Cancer 45:1798–1806
Craig P, Dieppe P, Macintyre S, et al. (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J 337:979–983
Acknowledgments
We thank participating health professionals and patients at Monash Medical Centre, Melbourne; John Hunter Hospital, Newcastle; Royal Brisbane and Women’s Hospital, Brisbane; and Haematology and Oncology Clinics of Australasia, Brisbane. We thank BaCT at Peter MacCallum Cancer Centre for data management and research personnel including Amy Finlay, Nathalie Darlison, Jane Campbell, Sally Licence, and Kerry Fleming. We especially acknowledge Damien Jolley who developed the methodology for the study. Damien died from melanoma on 15.2.2013, and his colleague Andrew Forbes generously undertook statistical analysis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Disclosures
None.
Funding
beyondblue: the national depression initiative. (Study ID:631570)
The funding body had no role in the study design, collection, analysis or interpretation of data, or writing of report, or decision to submit for publication. The authors have no financial relationship with the funding source. The authors have full control of all primary data and agree to allow the journal to review data if requested.
Ethical approval
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Additional information
This trial is registered with the Australian and New Zealand Clinical Trials Registry. ANZCTR 1260000448044.
Damien Jolley died prior to completion of the trial.
Rights and permissions
About this article
Cite this article
Turner, J., Kelly, B., Clarke, D. et al. A tiered multidisciplinary approach to the psychosocial care of adult cancer patients integrated into routine care: the PROMPT study (a cluster-randomised controlled trial). Support Care Cancer 25, 17–26 (2017). https://doi.org/10.1007/s00520-016-3382-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-016-3382-0