Walker, J., Hansen, C., Holm, Martin, P., Symeonides, S., Gourley, C., Wall, L., . . . Sharpe, M. (2014). Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): A multicentre randomised controlled trial in patients with lung cancer. Lancet Oncology, 15, 1168–1176.
DOI Link
Study Purpose
To assess the efficacy of an integrated treatment program for major depression in patients with lung cancer compared to usual care
Intervention Characteristics/Basic Study Process
Nurses were specially trained to deliver psychological interventions to patients who were physically deteriorating. The training emphasized the achievement of competency and included tutorials and role-play among other methods. The trained nurses provided 10 structured sessions with patients, usually in their homes, immediately following the diagnosis of depression. Additional treatment was provided by phone and, for those patients who did not meet targets, additional treatment was provided.
Sample Characteristics
- N = 142
- AVERAGE AGE = 63.8 years (range = 40.7–82.2 years)
- MALES: 35%, FEMALES: 65%
- KEY DISEASE CHARACTERISTICS: The majority of patients were diagnosed with lung cancer, and most of those diagnoses were non-small cell lung cancer.
- OTHER KEY SAMPLE CHARACTERISTICS: The majority of patients were retired and had a spouse or partner.
Setting
- SITE: Multi-site
- SETTING TYPE: Outpatient
- LOCATION: Scotland, United Kingdom
Phase of Care and Clinical Applications
- PHASE OF CARE: Multiple phases of care
- APPLICATIONS: Elder care, palliative care
Study Design
Randomized, controlled trial
Measurement Instruments/Methods
- Hopkins Symptom Checklist (SCL-20) depression scale version B (20 items rated 0–4)
Results
Average depression severity was significantly lower in patients allocated to the intervention group. Care was given by a nurse who usually visited patients in their homes. Depression improvement was self-rated. Improvement was seen in anxiety, quality of life, role functioning, perceived quality of care, and the proportion of patients achieving a 12-week treatment response.
Conclusions
In this study, the intervention proved to be more effective than usual care in reducing depression severity. Participants also saw improvements in anxiety, quality of life, and role functioning.
Limitations
- Risk of bias (sample characteristics)
- Unintended interventions or applicable interventions not described that would influence results
- Measurement/methods not well described
- Intervention expensive, impractical, or training needs
- Other limitations/explanation: Psychiatrists also prescribed medications. I was difficult to determine which parts of the intervention were effective.