Girgis, A., Breen, S., Stacey, F., & Lecathelinais, C. (2009). Impact of two supportive care interventions on anxiety, depression, quality of life, and unmet needs in patients with nonlocalized breast and colorectal cancers. Journal of Clinical Oncology, 27, 6180–6190.

To determine if, compared to individuals receiving usual care, participants in intervention groups would report lower levels of anxiety, depression, and unmet supportive care needs along with improved physical and emotional functioning

• Patients were randomly assigned to one of three supportive care models: UC (control), O/GP (oncologist/GP), or TCW (telephone caseworker). Participants completed three computer-assisted telephone interviews (CATIs) conducted by trained interviewers: one each at baseline and at three and six months.
• Data obtained from participants in the UC model were used only to assess the impact of supportive care models.
• The O/GP model included two copies of sheets listing concerns: One sheet was mailed to the oncologist, so he or she would know what concerns to discuss at the next appointment. The other sheet was for records.
• The TCW model consisted of telephone interviews conducted by oncology nurses with training in by-telephone interviewing. Interviewers discussed the content of TCW sheets, which listed issues of concern that patients had expressed. TCW interviewers followed up at six-week intervals to assess coping.

• The sample was composed of 356 participants.
• Mean patient age in the UC (control) group was 57.4 years. The age range in the UC group was 28–75 years. Mean patient age in the O/GP group was 58.3 years. The age range in the O/GP group was 37–75 years. Mean patient age in the TCW group was 57.8 years. The age range in the TCW group was 33–75 years.
• The number of females in the sample was 257. The percentage of females in the sample ranged from 71.8% through 72.5%. The number of males in the sample was 99. The percentage of males in the sample ranged from 27.5% through 28.2%.
• The percentage of participants with nonlocalized breast cancer ranged from 48.7% through 49.2%; with nonlocalized colon cancer, 50.8% through 51.3%

• Single site
• Home
• New South Wales, Australia

• Phase of care: active treatment and transition
• Clinical application: late effects

Parallel-group, prospective randomized controlled trial

• Hospital Anxiety and Depression Scale (HADS)
• European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire, version 3.0 (EORTC QLQ-C30 version 3.0)
• Supportive Care Needs Survey-Short Form (SCNS-SF34), to measure perceived need for care
• 10 items from the Needs Assessment for Advanced Cancer Patient (NA-ACP)
• Perceived improvement in patient communication with health care practitioners was measured at the third CATI by means of one question, on a 5-point Likert scale: “Participating in this study made it easier to discuss my health care needs and issues with my doctors and other health care practitioners.”

• Authors observed no overall intervention effect.
• Members of the TCW group were more likely (p < 0.0001) to have issues discussed and referrals recommended than were those in the O/GP group. This was particularly true in regard to unmet psychological need (p < 0.01), need relating to daily living (p < 0.01), health service/information need (p = 0.01), and physical need (p < 0.01).
• Compared to oncologists and GPs, case workers were more likely to discuss anxiety (p = 0.01) and unmet psychological needs (p < 0.01).
• Oncologists and GPs were more likely (p = 0.02) to discuss unmet patient care and support needs.
• Authors noted no significant intergroup differences in regard to proportion of participants with elevated anxiety and depression at any of the three time points.
• QOL scores improved within study groups across times, but authors detected no significant between-group differences.

Authors noted no significant intervention effect in this study, with the exception of improved physical functioning at six months for the TCW group.

• Individuals who were too distressed or unwell to participate were excluded from the study. These patients may have been the very ones who most needed the intervention. 
• Authors provided no information about or consideration of disease stage, treatment phase, or other symptoms that can affect the outcomes the study measured.

Nurses should continue to explore ways to reach patients, at the time of diagnosis and beyond treatment, that can assist patients in psychosocial functioning. The field needs tools to make this easier; nurses need ways to implement care efficiently. The study did not show telephonic intervention to be effective.