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- Title
Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting.
- Authors
Steel, Jennifer L.; Geller, David A.; Kim, Kevin H.; Butterfield, Lisa H.; Spring, Michael; Grady, Jonathan; Sun, Weiing; Marsh, Wallis; Antoni, Michael; Dew, Mary Amanda; Helgeson, Vicki; Schulz, Richard; Tsung, Allan
- Abstract
<bold>Background: </bold>The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life.<bold>Methods: </bold>A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression.<bold>Results: </bold>At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm.<bold>Conclusions: </bold>The integration of screening and symptom management into cancer care is recommended.
- Subjects
UNITED States; CANCER research; DISEASES; TUMORS; PALLIATIVE treatment; THERAPEUTICS; CHRONIC pain treatment; PREVENTION of mental depression; MENTAL depression; FATIGUE prevention; TUMOR treatment; FATIGUE (Physiology); TUMORS &; psychology; CHRONIC pain; ANALYSIS of variance; PSYCHOLOGY of caregivers; CHI-squared test; COMPARATIVE studies; COOPERATIVENESS; INTERNET; RESEARCH methodology; MEDICAL cooperation; COMPUTERS in medicine; QUALITY of life; REGRESSION analysis; RESEARCH; RESEARCH funding; RISK assessment; DISEASE management; EVALUATION research; RANDOMIZED controlled trials; TREATMENT effectiveness; EVALUATION of human services programs; PREVENTION
- Publication
Cancer (0008543X), 2016, Vol 122, Issue 8, p1270
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.29906