In a phase III trial reported in The Lancet, Jennifer Steel, PhD, and colleagues found that an integrated screening and stepped collaborative care intervention (CARES) improved health-related quality of life vs standard of care in patients with cancer.
Jennifer Steel, PhD
Study Details
In the study, 459 patients from 29 oncology outpatient clinics associated with the UPMC Hillman Cancer Center, Pittsburgh, were randomly assigned to receive stepped collaborative care (n = 237) or standard of care (n = 222) between December 2016 and April 2021. Eligible patients were aged ≥ 21 years, with any cancer type, and had clinical levels of depression, pain, or fatigue. Stepped collaborative care consisted of once-weekly cognitive behavioral therapy (CBT) for 50 to 60 minutes via telemedicine (telephone or videoconferencing). Patients initially received at least 8 to 12 sessions of CBT.
Pharmacotherapy for symptoms could be initiated or changed if recommended by the treatment team or preferred by the patient. If symptoms persisted above the clinical range at 12 weeks, additional treatment was provided (eg, psychotherapy or starting or changing pharmacologic treatment) for up to 6 months. Standard of care consisted of screening and referral to a health-care provider for treatment of symptoms. The primary outcome measure was health-related quality of life at 6 months as assessed by the Functional Assessment of Cancer Therapy-General instrument.
Key Findings
Patients in the stepped collaborative care group had greater improvement in health-related quality of life at 6 months compared with the standard-of-care group (P = .013), including significant improvement in emotional (P = .012), functional (P = .042), and physical (P = .033) domains. Health-related quality of life improvements were maintained at 12 months in the stepped collaborative care group (P = .74 for 6 vs 12 months).
Patients in the stepped collaborative care group had greater reductions in depressive symptoms, pain, and fatigue, with the benefits being maintained at 12 months.
The investigators concluded “An integrated screening and novel stepped collaborative care intervention, compared with the current standard of care, is recommended to improve health-related quality of life. The findings of this study will advance the implementation of guideline-concordant care (screening and treatment) and has the potential to shift the practice of screening and treatment paradigm nationwide, improving outcomes for patients diagnosed with cancer.”
Dr. Steel, of the Department of Surgery and Department of Psychiatry, University of Pittsburgh School of Medicine, is the corresponding author for The Lancet article.
Disclosure: The study was funded by the National Cancer Institute. For full disclosures of the study authors, visit thelancet.com.
