In a Canadian study reported in the Journal of Clinical Oncology, McCusker et al found that a telephone-supported depression self-care intervention called CanDirect was effective in managing mild-to-moderate depression symptoms in cancer survivors.
Study Details
The study involved 245 patients who had completed cancer treatment within the past 10 years who had mild/moderate depressive symptoms with or without major depression recruited from clinical and community settings in Quebec and Ontario. Between September 2016 and October 2018, patients were randomly assigned to the CanDirect intervention plus usual care (n = 121) or usual care alone (n = 124).
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Patients in the CanDirect group received the Depression Self-Care Toolkit for Cancer Survivors in paper format or on a secure website and were offered lay telephone coaching guided by a structured manual to activate and guide participants through the materials, help in selecting appropriate tools, and provide positive reinforcement. The coaches were female nonprofessionals (students with bachelor-level nursing or psychology degrees or retired nurses) who were trained and supervised by a clinical psychologist.
The primary outcome measure was depression severity at 6 months as assessed by the Center for Epidemiological Studies-Depression scale (CES-D) in the intent-to-treat population. Analyses of outcomes were adjusted for covariates using linear regression and missing data by inverse probability weighting.
Key Findings
Among 245 participants randomly assigned, 218 (89.0%) completed the primary outcome at 6 months, including 100 in the CanDirect group and 118 in the usual care group. Among 121 patients in the intervention group, 113 (93.4%) received at least one coach call; the mean number of coach calls was 7.8, and the mean length of calls was 15.1 minutes.
On intent-to-treat analysis, patients in the CanDirect group reported less severe depressive symptoms on the CES-D vs the usual care group at 6 months, with an adjusted effect size (ES) of 0.61 (95% confidence interval = 0.33–0.88, P < .001).
The CanDirect group had significantly better outcomes in the following categories:
- Health-related quality of life on the Short Form Survey-12 mental (ES = .049, P < .001) and physical component (ES = 0.27, P = .047) summary scales
- Lower anxiety on the Hospital Anxiety and Depression Scale (ES = 0.34, P = .02)
- Greater activation (patient knowledge, skill, and confidence for self-management) on the Patient Activation Measure (ES = 0.29, P = .041)
- Reduced rates of major depression based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (odds ratio = 0.31, P = .04).
In an exploratory analysis, sex was a modifier of the primary outcome (P = .03 for interaction), with the CanDirect intervention being less effective in men (ES = 0.12, P = .68) vs women (ES = 0.86, P < .001).
The investigators concluded: “The findings suggest that CanDirect is an effective method of managing mild/moderate depression symptoms in cancer survivors.”
Jane McCusker, MD, DrPH, of St. Mary’s Research Centre, Montreal, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by an award from the Canadian Cancer Society. For full disclosures of the study authors, visit ascopubs.org.
