Adding specialized mental health support to the treatment plan of patients with cancer may improve their quality of life, lower the risk of cardiovascular disease in family caregivers, and boost cost savings to the health-care system, according to a recent study published by Steel et al in The Lancet.
Background
Previous studies have shown that symptoms such as depression and pain may be associated with higher rates of emergency room visits and hospital readmissions, greater health-care costs, and poorer survival. For nearly 20 years, screening for these symptoms and referral for treatment has been the standard of care in cancer centers across the United States, Canada, Europe, and Australia. However, various barriers may prevent the majority of patients from initiating treatment.
“The current standard of care … is not working,” stressed lead study author Jennifer Steel, PhD, Professor of Surgery, Psychiatry, and Psychology at the University of Pittsburgh School of Medicine. “Our integrated screening and treatment program provides meaningful support to patients and can save hospitals millions of dollars by preventing readmissions,” she added.
Study Methods and Results
In the recent phase III clinical trial, researchers divided 459 patients into either a standard referral to a provider group or an integrated screening and stepped collaborative care intervention group—in which participants were connected with a trained social worker or counselor for 8 to 12 weekly cognitive behavioral therapy (CBT) sessions that were integrated into their cancer care plan. The patients were also offered medical treatment if CBT alone did not provide substantial benefits.
The patients underwent traditional CBT strategies, including identifying and changing their automatic thoughts, partaking in relaxation techniques, and altering core beliefs about themselves or their environment. The CBT sessions focused on the reduction of pain and fatigue by improving sleep hygiene and increasing physical activity.
After a follow-up of 6 months, the researchers found that compared with those in the standard group, the patients in the intervention group saw greater improvements in their emotional, physical, and functional well-being that persisted up to 1 year following the initiation of the specialized mental health support. Additionally, the patients who took part in the collaborative care intervention experienced fewer emergency room visits and readmissions within 90 days as well as shorter hospital visits, which reduced costs to the health-care system. The researchers reported that even if the collaborative care intervention was offered to patients for free, hospitals were able to save more than $4 million for every 250 patients.
Conclusions
“Preserving or improving quality of life while undergoing treatment for cancer is our goal, and for some patients, it is as important as survival,” Dr. Steel emphasized. “We hope our findings may shift the paradigm in the way in which we screen and treat these symptoms, while at the same time provide meaningful support to patients,” she concluded.
Disclosure: The research in this trial was supported by the National Cancer Institute. For full disclosures of the study authors, visit thelancet.com.
