For cancer patients in dispersed urban and rural areas, telephone-based care management and home-based automated symptom monitoring may provide an effective means of managing pain and depression.
In a study by Kurt Kroenke, MD, of the Regenstrief Institute in Indianapolis and colleagues, patients from 16 community-based oncology practices with symptoms of depression, cancer-related pain, or both, were randomly assigned to the intervention or usual care (JAMA 2010;304:163-171). The trial ran from March 2006 to August 2008, with follow-up concluding in August 2009.
Patients in the intervention group received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or Internet. Telephonic care management was delivered by a nurse care manager trained in assessing symptom response and medication adherence; providing pain and depression-specific education; and in making treatment adjustments according to evidence-based guidelines. Depression and pain symptoms were assessed at the beginning of the trial and at months 1, 3 ,6, and 12.
Of the 274 patients with pain, the 137 patients in the intervention group had greater improvements in pain severity, as assessed by the Brief Pain Inventory ,over the 12 months of the trial than the 137 patients in the usual-care group. Of the 309 patients with depression, the 154 patients in the intervention group had significantly greater improvement in depression severity, as assessed by the Hopkins Symptom Checklist, than the 155 patients in the usual-care group.
Between-group differences in secondary outcomes that were not pain- or depression-specific were also assessed, and the intervention group had better outcomes for several health-related quality of life domains, including mental health, vitality, anxiety, and physical symptom burden.
The authors conclude that “the fact that [the program] was beneficial for the most common physical and psychological symptoms in cancer patients demonstrates that a collaborative care intervention can cover several conditions, both physical and psychological.”