Pugliese, P., Perrone, M., Nisi, E., Garufi, C., Giannarelli, D., Bottomley, A., & Terzoli, E. (2006). An integrated psychological strategy for advanced colorectal cancer patients. Health and Quality of Life Outcomes, 4, 1–9.

This study describes an integrated approach that includes a qualified psychotherapist as an active part of the oncology team. The first consultation with the patient included a PhD-level specialist. The oncologist asked the patient for both medical and psychological treatment consent. The psychologist performed psychological evaluations; conducted structured interviews; and measured, observed, and supported patients. One aim of the study was to evaluate feasibility of this integrated approach.

Outcomes measured included anxiety and depression, adaptation and awareness, and subjective perception of medical treatment quality. Outcome data were collected before and after 18 weeks of chemotherapy.

The sample was composed of 98 participants with metastatic or locally advanced colorectal cancer.

• Single site
• Cancer institute
• Rome, Italy

Prospective, nonrandomized design

• Hospital Anxiety and Depression Scale (HADS)
• European Organization for Research and Treatment quality of life questionnaire (EORTC QLQ-C30)

Prior to treatment 30% (29 patients) were found to have psychopathologic disorders. With the total of 294 psychodynamic interviews conducted, the McNemar test showed a significant improvement in terms of adaptation and awareness between pretreatment and 18 weeks. The mean HADS score initially was 4.9 ±2.9 for anxiety and 5.5 ±3.4 for depression, showing no abnormal depression or anxiety. After 18 weeks, the scores for anxiety decreased (p < 0.02). No significant change occurred with depression. At the completion of 18 weeks of therapy, there was a significant increase in the number of patients having a positive experience on health-related quality of life (53% versus 70%), anxiety (49% versus 63%), depression (54% versus 69%), interpersonal relationships (61% versus 79%), free time (61% versus 73%), and positive perception of treatment quality.

The results show the feasibility and some evidence of the benefit of the integrated approach to oncology care. Patients seemed to have a positive inner experience regarding the physician-patient relationship.

• The study was prospective and nonrandomized. It did not include a control group and was conducted at one site only.
• The study did not specify the exact actions of the psychologist.