Pilot RCT of a telehealth intervention to reduce symptoms of depression and anxiety in adults with cystic fibrosis.

BACKGROUND: Adults with cystic fibrosis (awCF) have higher levels of depression and anxiety than community samples. The Coping and Learning to Manage Stress with CF (CALM) intervention was developed for awCF reporting elevated symptoms of depression or anxiety. METHODS: In this pilot study, awCF were randomly assigned to either six telehealth sessions (CALM; n = 15) or treatment-as-usual (TAU; n = 16). Primary outcomes were depression and anxiety. Secondary outcomes were coping self-efficacy and health-related quality of life (HrQOL). Tertiary outcomes were feasibility, acceptability, and satisfaction. Assessments were completed at baseline, post-intervention, and 3-month follow-up. Group differences were examined via independent samples t-tests. Effect size (ES) was calculated via Cohen's d to provide a measure of the magnitude of the treatment effect. RESULTS: At post-intervention, the CALM group had a lower mean score than the TAU group for depression (medium ES) and anxiety (large ES). The CALM group had higher (i.e., better) mean scores than the TAU group for coping (large ES) and HrQOL domains of Social Functioning (large ES) and Vitality (large ES). Most treatment gains were not sustained at 3-month follow-up. CALM was feasible, requiring <12 min. for setup and scheduling, and allowed seamless participation when hospitalized. Mean scores for acceptability and satisfaction indicated that most participants either agreed or strongly agreed that CALM was acceptable and satisfactory. CONCLUSIONS: CALM shows promise as an intervention to reduce symptoms of depression and anxiety and improve coping and HrQOL. Next steps are to add a booster session and examine CALM via a multi-site RCT.

Treatment challenges and support needs of underserved Hispanic patients diagnosed with lung cancer and head-and-neck cancer.

Purpose: We explored the treatment challenges and support needs that Hispanic underserved lung cancer and head-and-neck cancer patients face while undergoing cancer treatment.Design: Qualitative design - ethnography.Sample: Using a sample of 29 participants, we conducted semi-structured interviews with nine lung cancer and head-and-neck cancer survivors and seven health care providers and focus group interviews with six caregivers and seven patient navigators.Method: Relevant themes were extracted with Ethnographic content analysis.Findings: Participants reported treatment challenges and support needs in four areas: medical, financial, socio-cultural, and mental health. Health care providers and navigators primarily identified medical and financial challenges that impact treatment adherence, while patients and caregivers expressed the need for support for mental health problems (i.e., depression, anxiety).Implications for psychosocial providers: Understanding the experiences of underserved Hispanic cancer survivors can aid in creating psychosocial interventions that successfully target treatment-related challenges and provide them with the support they need.

Feasibility of EASE: a psychosocial program to improve symptom management in head and neck cancer patients.

PURPOSE: Head and neck cancer (HNC) patients experience multiple physical and psychosocial symptoms associated with their cancer treatment. The Easing and Alleviating Symptoms during Treatment (EASE) study utilized a mixed methods design to examine the feasibility of a tailored telephone-based coping and stress management intervention to improve symptom management and psychosocial care among HNC patients. METHODS: An Embedded Correlational Mixed Methods Design was utilized to answer two research questions: (1) is the EASE intervention feasible? and (2) Did EASE participants report improvements in psychosocial outcomes after completion of the EASE intervention? HNC patients were assessed at baseline and 3 months. Psychosocial measures included cancer-specific distress, pain, social support, and quality of life. Project records and exit interviews were conducted to assess acceptability and satisfaction with the intervention. RESULTS: The mean age of the participants was 60 years (SD = 9.5), 76 % were male, 47 % married/partnered, and 57 % had a history of tobacco use. Of the 24 participants who were enrolled, 16 completed the intervention. Participants and telephone counselors reported high levels of satisfaction. Although the small sample size and lack of a control group limit our ability to assess the efficacy of the intervention, our findings suggest that the intervention helped to buffer the negative emotional and physical impact of cancer treatment. CONCLUSIONS: This pilot study demonstrated that the EASE intervention is feasible and acceptable to HNC cancer patients undergoing treatment. The study findings revealed some challenges of implementing a psychosocial intervention in HNC patients and inform future intervention studies with this population.

Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer.

BACKGROUND: Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients. METHODS: Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided. RESULTS: Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07). CONCLUSIONS: Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.

Feasibility of a telephone-based counseling program for informal caregivers of hospice patients.

OBJECTIVES: Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The Caregiver Life Line (CaLL) study was a one-group, intervention-only feasibility study of a telephone cognitive-behavioral stress-management intervention consisting of 10 to 12 weekly telephone counseling calls designed specifically for informal caregivers of home-based hospice patients. METHODS: Caregivers, who were recruited via seven participating hospices, were assessed at baseline, 3, and 6 months. Psychosocial measures included depression, perceived stress, benefit finding, social support, and quality of life (QoL). Process evaluation was also conducted at 6 months. RESULTS: Of the 25 participants, 19 completed the 12-week intervention. The mean age was 60.3 years; 91% were female and 70% married. Forty-eight percent were caring for a spouse; 51% were caring for a parent or other family member. Participating caregivers and hospice staff reported high levels of satisfaction with the intervention. Although the small sample size and lack of a control group limit our ability to assess the efficacy of the intervention, psychosocial outcomes changed in the expected direction and participants reported high levels of self-efficacy regarding their ability to implement the adaptive coping skills. Interestingly, we observed a decrease in physical QoL across the three time points. CONCLUSIONS: This pilot study demonstrated that the CaLL intervention is feasible and acceptable to informal hospice caregivers. This report describes important lessons learned from the pilot study with the intention of informing future intervention studies with this population.

Bereavement: addressing challenges faced by advanced cancer patients, their caregivers, and their physicians.

Physicians who work with advanced cancer patients need to be aware of the process of grief and bereavement not only in terms of how it may impact the patient and family, but in how it can affect their own emotions and behavior. There are a number of simple things that physicians can do to normalize and promote adaptive grieving in advanced cancer patients and their families. Patients facing the end of life face enormous physical and existential challenges. Yet from this challenge there is the potential for enormous growth and a "good death" for the patient as well as an opportunity for the family to strengthen their relationship with the patient and find positive meaning in their caretaking activities. In addition to caring for the patient and family, physicians must be attentive to their own needs, which include acknowledging feelings of grief and loss and pursuing healthy venues that promote adaptive coping and decrease the risk of detachment and burnout. Despite the physical, emotional and spiritual demands of working with end-of-life patients and their families, being open and willing to face these challenges can lead to positive growth and increased meaning for all involved.

Support needs of informal hospice caregivers: a qualitative study.

BACKGROUND: Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The goal of this qualitative study was to understand caregivers' needs to inform the feasibility, structure, and content of a telephone-based counseling intervention. METHODS: Focus groups and interviews with 36 former hospice caregivers and 11 hospice staff from 6 hospices were conducted. Interviews and focus groups were audio-recorded, transcribed, and analyzed using a constant comparative approach. RESULTS: Key content areas included coping, emotional support, self-care, logistical issues, and bereavement. Respondents supported telephone-based counseling, appreciating its relative anonymity and convenience. It was recommended that calls be initiated by the counselor, on a weekly basis, and that one counselor be assigned to each caregiver. Hospice staff emphasized the need to coordinate telephone counseling with hospice care, scheduling around and communicating with hospice staff. Most caregivers indicated that they would participate in telephone-based counseling were it available; hospice staff thought that half of caregivers would participate. A pervasive theme was that "there can never be enough support for a caregiver." CONCLUSION: Informal caregivers of hospice patients have support needs that are amenable to telephone-based counseling designed to be complementary to existing hospice services. Based on these qualitative findings, we are pilot-testing a telephone-based cognitive-behavioral stress management program for informal caregivers of hospice patients.

Fatigue in systemic lupus erythematosus: contributions of disease activity, pain, depression, and perceived social support.

OBJECTIVE: Pain and psychological distress are associated with fatigue, and social support may play a buffering role in the adjustment to a chronic disease. Investigations of the relationship between fatigue and disease activity in chronic diseases have provided inconclusive findings. The influence of medications on perceived fatigue remains unclear. We investigated the relationship between pain, depression, fatigue, and disease activity in patients with systemic lupus erythematosus (SLE). METHODS: Participants (n = 127) completed a psychosocial questionnaire during routine clinic visits. Hierarchical multiple regression analysis was conducted to predict the contribution of disease activity, pain, depression (Beck Depression Inventory), and perceived social support to fatigue. RESULTS: Disease activity as measured by SLE Disease Activity Index (SLEDAI) did not significantly predict self-reported levels of fatigue. Medication usage did not predict fatigue levels. Pain and depression were both unique positive predictors of fatigue. Controlling for pain and depression, perceived social support contributed negatively to the variance in fatigue scores, suggesting a buffering effect. This model reliably explained 42% of the variance in fatigue scores. CONCLUSION: Our results emphasize the importance of depression, pain, and perceived social support in predicting reported fatigue levels in patients with SLE. In contrast, disease activity measured by SLEDAI does not appear to account for fatigue in SLE. Understanding the effect of psychosocial factors on fatigue in SLE may improve patient outcomes through psychosocial interventions aimed at reducing pain and increasing coping skills and social support.