van der Meulen, I.C., May, A.M., Ros, W.J., Oosterom, M., Hordijk, G.J., Koole, R., & de Leeuw, J.R. (2013). One-year effect of a nurse-led psychosocial intervention on depressive symptoms in patients with head and neck cancer: A randomized controlled trial. The Oncologist, 18, 336–344.

To investigate the effects of a psychosocial nurse counseling and after intervention (NUCAI) versus usual care on symptoms of depression and physical symptoms related to the head or neck cancer (HNC) of patients one year after the diagnosis of HNC.

The NUCAI consisted of six bimonthly 45-minute counseling sessions. NUCAI is a problem-focused method aimed at helping patients to manage the physical, psychological, and social consequences of HNC and its treatment. The intervention consisted of these components: evaluating current mental status, discussing current problems, systematically asking about physical problems and functioning, and providing the adjustment to the fear, threat or expectation of recurrence (AFTER) intervention. AFTER was nurse led. During one year, six sessions were provided with usual and regular medical follow-up visits. Usual care involved 10-minute appointments every two months, for examination and review. Patients were randomly assigned to the intervention or control group. Data were collected every three months for one year.

• The initial sample was composed of 205 participants with HNC. The final analysis included 150 participants.
• Mean patient age in the intervention group was 60.1 years; in the usual-care group, 60.7 years.
• The intervention group comprised 70.5% males and 29.5% females. The control (usual-care) group comprised 70.3% males and 29.7% females.
• The majority of patients in both groups were married. Cancer of the oral cavity was the most common cancer diagnosis among the patients.

• Single site
• Outpatient
• The Netherlands

Transition phase after active treatment

Randomized controlled trial

• Self-report questionnaires for age, gender, education level, and social status
• Medical records review for treatment, tumor type, and stage
• Center for Epidemiological Studies Depression Scale (CESD) (primary outcome)
• European Organization for Research and Treatment questionnaire for quality of life of cancer patients (EORTC QLC) for physical symptoms (secondary outcome)

• In the intervention group, 11.7% of patients did not attend sessions.
• Treatment fidelity is documented by using trained, experienced oncology nurses to conduct the intervention.
• One year after HNC treatment, levels of symptoms of depression were significantly lower in the intervention group than in the control group ( p < 0.05, –5.2 change with intervention). Overall physical symptoms decreased more in the intervention group than in the control group, with a significant decrease in pain and symptoms related to swallowing and opening the mouth.

Study findings showed significant reduction in depression; therefore, this intervention can be used in clinical settings to improve patient outcomes (e.g., reduction of depression and improvement of physical symptoms).

• The study had a risk of bias due to no appropriate attentional control condition.
• Protocol fidelity was questionable.
• Subject withdrawals ≥ 10%.
• At 12 months, 55 patients were lost to follow-up. In terms of age and education, findings showed a significant difference between patients who were lost to follow-up and patients who completed the study through 12 months. Patients who were lost to follow-up were older and more educated and had an advanced stage of tumor. Of all participants, 27% were lost to follow-up.
• Because all sessions occurred at clinic follow-up appointments, the potential for contamination or other relevant threats to validity is unknown.

This study utilized a nurse-led intervention for reduction of symptoms of depression in HNC patients. With proper training nurses can be equipped with the skill of providing psychological counseling to patients. Investigators noted  that, compared to the cost of counseling offered by a clinical psychologist or psychiatrist, the nurse-led intervention seems a cost-effective method.