Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting

Jennifer L. Steel, David A. Geller, Kevin H. Kim, Lisa H. Butterfield, Michael Spring, Jonathan Grady, Weiing Sun, Wallis Marsh, Michael H Antoni, Mary Amanda Dew, Vicki Helgeson, Richard Schulz, Allan Tsung

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

BACKGROUND: The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life. METHODS: A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression. RESULTS: At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (ϕ = 0.18), IL-1β (ϕ = 0.35), IL-1α (ϕ = 0.19), and IL-8 (ϕ = 0.15) and increases in NK cell numbers (ϕ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm. CONCLUSIONS: The integration of screening and symptom management into cancer care is recommended.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - 2016

Keywords

  • Biobehavioral psychology oncology
  • Collaborative care
  • Depression
  • Pain
  • Quality of life

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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    Steel, J. L., Geller, D. A., Kim, K. H., Butterfield, L. H., Spring, M., Grady, J., Sun, W., Marsh, W., Antoni, M. H., Dew, M. A., Helgeson, V., Schulz, R., & Tsung, A. (Accepted/In press). Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting. Cancer. https://doi.org/10.1002/cncr.29906