Kroenke, K., Theobald, D., Wu, J., Norton, K., Morrison, G., Carpenter, J., & Tu, W. (2010). Effect of telecare management on pain and depression in patients with cancer: A randomized trial. JAMA, 304, 163–171.

To determine whether centralized telephone-based care management and automated symptom monitoring can reduce depression and pain in patients with cancer

Participants in the intervention group received centralized telecare management, conducted by a nurse-physician specialist team, and automated home-based symptom monitoring by means of interactive voice recording or Internet. The control group received usual care. Data were collected at baseline and at months 1, 3, 6, and 12.

• The sample was composed of 405 participants, 202 in the intervention group and 203 in the control group.
• In the intervention group, mean patient age was 58.7 years (SD = 11.0). In the control group, mean patient age was 59 years (SD = 10.6 years).
• Most participants, more than 60%, were female.
• The sample included cancers of diverse types and stages.
• To be eligible, patients had to have depression, pain, or both as defined by a score of at least 10 on the Patient Health Questionnaire-9 (PQ-9) or a score of at least 6 on the Brief Pain Inventory (BPI).

• Multisite
• Outpatient
• Indiana, United States

Random controlled trial with double blinding, with stratified randomization by symptom type (pain only, depression only, or both pain and depression)

• Twenty-item Hopkins Symptom Checklist (HSCL-20), to measure severity of depression
• Brief Pain Inventory (BPI), to measure severity of pain
• A single-item 0–10 scale, to measure overall quality of life
• SF-12, to provide physical-component and mental-component summary scores
• Generalized Anxiety Disorder Scale, to measure anxiety
• Somatic Symptom Scale, to measure physical-symptom burden

• The number of patients with pain was 274. Over the 12 months of the trial, the 137 patients in the intervention group had greater improvements in pain severity, as measured by BPI scores, than did the 137 patients in the usual-care group (p < 0.001).
• The number of patients with depression was 309. Over the 12 months of the trial, the 154 patients in the intervention group had greater improvements in HSCL-20 scores than did the 155 patients in the usual-care group (p < 0.001). The HSCL-20 scores of the intervention group decreased at least 50%.
• The standardized effect size for between-group differences, at 3 and 12 months, was 0.67 and 0.39, repectively, for pain and 0.42 and 0.41, respectively, for depression.
• Compared to the usual-care group, the intervention group had better outcomes in several health-related quality-of-life domains.

The intervention may be effective at reducing pain and depression. The intervention proved to be a feasible care approach for geographically dispersed urban and rural oncology practices.

Lack of control over type of cancer treatment and over the time lapse since treatment might have affected study findings.

Cost will be involved in training the care manager and in hiring trained personnel. The cost-effectiveness of the collaborative care model needs to be further examined. Studies show mixed results regarding effect of by-telephone patient management; further work in this area is warranted. Use of technology may be a viable approach to ongoing patient support.