Ell, K., Xie, B., Quon, B., Quinn, D.I., Dwight-Johnson, M., & Lee, P.J. (2008). Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. Journal of Clinical Oncology, 26, 4488–4496.

To determine the effectiveness of Alleviating Depression Among Patients with Cancer (ADAPt-C) collaborative care management for major depression or dysthymia

ADAPt-C is collaborative care management developed for low-income and minority patients. The control group received enhanced usual care (EUC). Data collection occurred at baseline, 6 months, and 12 months. The intervention involved semistructured assessment and patient and family education, navigation assistance, behavioral therapy components in weekly sessions, and patient homework. After treatment initiation, patients received monthly telephone contact for up to 12 months, for maintenance and relapse prevention. Medication was used as clinically indicated for psychiatric symptoms. Overall management was based on guidelines, from the National Comprehensive Cancer Care Network, for treatment of depression in cancer patients. 

• N = 472 participants (242 in the intervention group  and 230 in the control group).
• Of participants, 49.4% was age 50 or older.
• Female: 84.5%; male: 15.5%.
• Participants had diverse cancer types at a variety of stages. Most participants (42.6%) had gynecologic cancer.
• Adult patients showed evidence of depression or dysthymia after cancer diagnosis.
• Of all participants, 87.9% were Hispanic.
• Intervention and control groups differed at baseline in regard to emotional well-being and quality of life. Researchers noted lower well-being in the intervention group.
• The two groups differed in regard to percentage of foreign-born participants. The greater percentage was in the intervention group (p = 0.04).

• Single site
• Outpatient
• Southern California

Active treatment and transition

Prospective, randomized, controlled trial with simple blinding

• Patient Health Questionnaire-9 (PHQ-9) for the diagnosis of major depression and depression severity level
• Functional Assessment of Cancer Therapy-General (FACT-G)
• Medical Outcome Study 12-item Short-Form Health Survey (SF-12) for quality of life
• Brief Pain Inventory (Short Form)

• From baseline to the 12-month follow-up, 63.2% of intervention patients had a 50% or greater reduction in depression symptoms as assessed by the PHQ-9 depression scale. In comparison, 50% of patients in the EUC group had a 50% or greater reduction (p = 0.01).
• Researchers noted five-point reduction in the PHQ-9 score: 72.2% of intervention patients versus 59.7% of EUC (p = 0.02).
• Intervention patients had significantly better quality-of-life outcomes (p < 0.05).
• At the six-month follow-up, researchers found no difference between groups in regard to depression severity.
• Intervention patients experienced greater rates of depression treatment (p < 0.0001).

ADAPt-C collaborative care may be a feasible and effective means of reducing symptoms of depression in some cancer patients.

• The study may have had risks of bias due to large attrition (214 participants, or 45% of participants), lack of control over the type of cancer treatments, and the range of time lapses since treatment.
• The baseline differences in the emotional well-being subscale scores of the FACT-G and SF-12 mental component summary were not adjusted for the main analyses.
• Cost will be involved in training the team members (e.g., a clinical specialist) and in hiring these personnel.

ADAPt-C is a time- and personnel-intensive intervention that requires significant commitment on the part of the patient.