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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Patients with cancer are likely to experience clinically significant depressive symptoms, with depression negatively affecting quality of life, treatment adherence, and satisfaction with care. Low-income Hispanics are less likely to receive care for depression, but benefit with culturally appropriate care enhancements. A randomized clinical trial is proposed to test the effectiveness of a quality improvement intervention Multifaceted Oncology Depression Program (MODP) on depressive symptoms, functional status and quality of life, patient adherence to cancer treatment, and satisfaction with depression and cancer care among low-income predominantly Latino adults with cancer. Aimed at enhancing oncology care, MODP is designed to be integrated within public sector oncology care and is socio-culturally tailored. MODP includes an initial choice of antidepressant medications or structured Problem Solving Treatment (PST), patient/family depression education, depression treatment maintenance and relapse prevention counseling, depression care management based on a stepped care depression treatment algorithm; extension of the oncology care team with a Cancer Depression Clinical Specialist (CDCS), a case manager (CM) to provide health and systems navigation; a psychiatric consultant to provide supervision of the CDCS and consultation to oncologists; treatment adherence and outcome monitoring; and oncologist education on depression management. Cultural competency enhancements include: patient choice of first line treatment (med/PST) and degree of family participation in their depression care; PST tailored for Hispanic patients with cancer; bilingual, bicultural CM, CDCS; Spanish educational materials. Usual Care (UC) patients will receive the care and clinic services routinely provided to all patients with cancer plus an educational pamphlet (on depression and cancer, depression treatment, talking with your doctor about your depression, and community mental health care resources). With patient consent, the oncologist will be informed if UC patients screen positive for depression. The study will be conducted in a large public urban medical center oncology clinics serving low income, predominantly Latino patients. Following a depression screen, 350 adult patients with cancer who meet diagnostic criteria for major depression or dysthymia will be recruited and randomized to MODP or UC. Specific study outcomes will be examined at 6,12, and 18 months. The nature of relationships between socio-cultural and clinical factors and depression treatment adherence and outcomes care will be examined. A cost analysis will be conducted. Study Hypotheses: a) MODP will result in greater reduction of depressive symptoms (by increasing receipt of and adherence to appropriate depression treatment); b) in significant improvement in functional status, quality of life, and depression and cancer treatment adherence; and c) and satisfaction with care vs. UC. Secondary questions include what is the effect of MODP on symptoms such as pain and fatigue and functional impairment from these symptoms.