Randomized Controlled Trial of Collaborative Care Management of Depression Among Low-Income Patients With Cancer

School of Social Work and Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-0411, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 10/2008; 26(27):4488-96. DOI: 10.1200/JCO.2008.16.6371
Source: PubMed


To determine the effectiveness of the Alleviating Depression Among Patients With Cancer (ADAPt-C) collaborative care management for major depression or dysthymia.
Study patients included 472 low-income, predominantly female Hispanic patients with cancer age >or= 18 years with major depression (49%), dysthymia (5%), or both (46%). Patients were randomly assigned to intervention (n = 242) or enhanced usual care (EUC; n = 230). Intervention patients had access for up to 12 months to a depression clinical specialist (supervised by a psychiatrist) who offered education, structured psychotherapy, and maintenance/relapse prevention support. The psychiatrist prescribed antidepressant medications for patients preferring or assessed to require medication.
At 12 months, 63% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline as assessed by the Patient Health Questionnaire-9 (PHQ-9) depression scale compared with 50% of EUC patients (odds ratio [OR] = 1.98; 95% CI, 1.16 to 3.38; P = .01). Improvement was also found for 5-point decrease in PHQ-9 score among 72.2% of intervention patients compared with 59.7% of EUC patients (OR = 1.99; 95% CI, 1.14 to 3.50; P = .02). Intervention patients also experienced greater rates of depression treatment (72.3% v 10.4% of EUC patients; P < .0001) and significantly better quality-of-life outcomes, including social/family (adjusted mean difference between groups, 2.7; 95% CI, 1.22 to 4.17; P < .001), emotional (adjusted mean difference, 1.29; 95% CI, 0.26 to 2.22; P = .01), functional (adjusted mean difference, 1.34; 95% CI, 0.08 to 2.59; P = .04), and physical well-being (adjusted mean difference, 2.79; 95% CI, 0.49 to 5.1; P = .02).
ADAPt-C collaborative care is feasible and results in significant reduction in depressive symptoms, improvement in quality of life, and lower pain levels compared with EUC for patients with depressive disorders in a low-income, predominantly Hispanic population in public sector oncology clinics.

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    • "The latter may develop into several psychological symptoms such as depression, anxiety, and other forms of psychological morbidity (Reynolds, 2000; Landmark, 2001; Coward, 2004). Studies indicated that 20% to 35% of women with breast cancer showed a significant level of distress (Golden-Kreutz, 2004; Ell, 2008; Hegel, 2006). In women with early breast cancer, the prevalence of depression, anxiety, or both in one year after diagnosis is around twice that of the general female population (Burgess, 2005). "
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    ABSTRACT: Objective: Breast cancer as a most common invasive cancer in women, provoking mental disorders for patients. To adjust with this situation, patients use kind of coping style. In present study, we aimed to determine the relationship between mental disorders and coping style in women with breast cancer. Methods: This research was a correlational study. 127 women among all women with breast cancer who were referred to health centers in the city of Kermanshah randomly selected. To estimate psychological distress, DASS- 42 questionnaire, and coping strategies Billings and Moos questionnaire (1981) are used. Interactive effects were assessed by using the spss 17. Results: results show that there are significant positive relationships between anxiety, stress and depression with avoidance coping strategy. And high level of anxiety and depression provoking emotion coping strategy.The results of the stepwise regression showed that depression and stress are suitable predictors of avoiding coping style whereas to predict emotion coping strategy, stress and anxiety are valid. Conclusion: Mental disorders can be one of the important factors in characterize of coping style. Therefore our result demonstrates the importance of mental disorders on coping style in breast cancer.
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    • "Combined psychological and pharmacological treatment for depression is more effective than either approach alone (de Jonghe, Kool, van Aalst, Dekker, & Peen, 2001; Glik, 2004; Hirschfeld et al., 2002; Keller, McCullough, Klein, Arnow, Dunner, et al., 2000; Keller, McCullough, Klein, Arnow, et al., 2000; Pampallona, Bollini, Tibaldi, Kupelnick, & Munizza, 2004). Numerous authors have advocated a combined approach for the treatment of depression in cancer patients (Ell et al., 2008; Rodin et al., 2007; Strong et al., 2008) and have recommended evaluating alternatives to cognitive-behavioral therapy (Newell, Sanson-Fisher, & Savolainen, 2002). It is generally agreed that psychological interventions should be an integral part of cancer care (e.g., http:// "
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    ABSTRACT: Unlabelled: Mindfulness-based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial, MBNT was found to ameliorate anxiety and depression, improve functional dimensions of quality of life, and enhance treatment adherence. In this review, we describe MBNT and its technical characteristics in the context of other psychotherapeutic interventions for depression in cancer patients. We highlight needed adjustments to other narrative approaches and recommend clinical modifications tailored to the needs of cancer patients that are intended to encompass the client's initial depressive narrative. The narrative construction is supported by emotional regulation and attachment relationships on the one hand and by individual and social linguistic capabilities on the other. Through destabilization of the depressive narrative, MBNT facilitates the emergence of new meanings using both verbal and non-verbal techniques based on mindfulness. The attitude and practice of mindfulness are integrated throughout the therapeutic process. In summary, MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. Key practitioner message: In this review, we describe mindfulness-based narrative therapy (MBNT) for the treatment of depression in cancer patients. In a previous controlled trial, we found significant benefits of MBNT in terms of reducing depressive symptoms and improving treatment adherence and quality of life in depressed, non-metastatic cancer patients. Narrative construction is socially and neurobiologically derived. MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. MBNT is proposed as an interesting and promising intervention, particularly for patients with somatic pathologies.
    Clinical Psychology & Psychotherapy 09/2014; 21(5). DOI:10.1002/cpp.1847 · 2.59 Impact Factor
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    • "2); Katon et al. 2004 (study no. 10); Ell et al. 2008 (study no. 7); Van 't Veer-Tazelaar et al. 2009 (study no. "
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    ABSTRACT: Background: In stepped care models patients typically start with a low-intensity evidence-based treatment. Progress is monitored systematically and those patients who do not respond adequately step up to a subsequent treatment of higher intensity. Despite the fact that many guidelines have endorsed this stepped care principle it is not clear if stepped care really delivers similar or better patient outcomes against lower costs compared with other systems. We performed a systematic review and meta-analysis of all randomized trials on stepped care for depression. Method: We carried out a comprehensive literature search. Selection of studies, evaluation of study quality and extraction of data were performed independently by two authors. Results: A total of 14 studies were included and 10 were used in the meta-analyses (4580 patients). All studies used screening to identify possible patients and care as usual as a comparator. Study quality was relatively high. Stepped care had a moderate effect on depression (pooled 6-month between-group effect size Cohen's d was 0.34; 95% confidence interval 0.20-0.48). The stepped care interventions varied greatly in number and duration of treatment steps, treatments offered, professionals involved, and criteria to step up. Conclusions: There is currently only limited evidence to suggest that stepped care should be the dominant model of treatment organization. Evidence on (cost-) effectiveness compared with high-intensity psychological therapy alone, as well as with matched care, is required.
    Psychological Medicine 03/2014; 45(2):1-16. DOI:10.1017/S0033291714000701 · 5.94 Impact Factor
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