Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Apr 15;122(8):1270-82.
doi: 10.1002/cncr.29906. Epub 2016 Mar 11.

Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting

Jennifer L Steel  1   2   3 , David A Geller  2 , Kevin H Kim  2 , Lisa H Butterfield  4 , Michael Spring  5 , Jonathan Grady  5 , Weiing Sun  6 , Wallis Marsh  2 , Michael Antoni  7 , Mary Amanda Dew  8 , Vicki Helgeson  9 , Richard Schulz  3 , Allan Tsung  2
Affiliations
Randomized Controlled Trial

Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting

Jennifer L Steel et al. Cancer. .

Abstract

Background: The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life.

Methods: A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression.

Results: At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm.

Conclusions: The integration of screening and symptom management into cancer care is recommended.

Keywords: biobehavioral psychology oncology; collaborative care; depression; pain; quality of life.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosures and Conflicts of Interest: The authors have no financial disclosures or conflicts of interest

Figures

Figure 1
Figure 1
CONSORT diagram of enrollment and 6-months follow up
Figure 2
Figure 2
Home page of website
Figure 3
Figure 3
Socioeconomic disadvantage and symptom burden
Figure 4
Figure 4
Patients’ depressive symptoms and caregiver stress from baseline and 2- and 4-months follow-Up
Figure 5
Figure 5
Patient health-related quality of life and the caregiver depressive symptoms from baseline and 2- and 4-months follow-Up
See this image and copyright information in PMC

References

    1. NIH State-of-the-Science Statement on symptom management in cancer: pain, depression, and fatigue. NIH Consens State Sci Statements. 2002;19:1–29. - PubMed
    1. Atesci FC, Baltalarli B, Oguzhanoglu NK, Karadag F, Ozdel O, Karagoz N. Psychiatric morbidity among cancer patients and awareness of illness. Support Care Cancer. 2004;12:161–7. - PubMed
    1. Chen X, Zheng Y, Zheng W, et al. Prevalence of depression and its related factors among Chinese women with breast cancer. Acta oncologica (Stockholm, Sweden) 2009;48:1128–36. - PMC - PubMed
    1. Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12(Suppl 1):4–10. - PubMed
    1. Lynch BM, Steginga SK, Hawkes AL, Pakenham KI, Dunn J. Describing and predicting psychological distress after colorectal cancer. Cancer. 2008;112:1363–70. - PubMed

Publication types

MeSH terms