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Randomized controlled trial of collaborative care management of depression among low-income patients with cancer . PURPOSE To determine the effectiveness of the Alleviating Depression Among Patients With Cancer ( ADAPt-C ) collaborative care management for major depression or dysthymia . PATIENTS AND METHODS Study patients included 472 low-income , predominantly female Hispanic patients with cancer age > or= 18 years with major depression ( 49 % ) , dysthymia ( 5 % ) , or both ( 46 % ) . Patients were randomly assigned to intervention ( n = 242 ) or enhanced usual care ( EUC ; n = 230 ) . Intervention patients had access for up to 12 months to a depression clinical specialist ( supervised by a psychiatrist ) who offered education , structured psychotherapy , and maintenance/relapse prevention support . The psychiatrist prescribed antidepressant medications for patients preferring or assessed to require medication . RESULTS At 12 months , 63 % of intervention patients had a 50 % or greater reduction in depressive symptoms from baseline as assessed by the Patient Health Questionnaire-9 ( PHQ-9 ) depression scale compared with 50 % of EUC patients ( odds ratio [ OR ] = 1.98 ; 95 % CI , 1.16 to 3.38 ; P = .01 ) . Improvement was also found for 5-point decrease in PHQ-9 score among 72.2 % of intervention patients compared with 59.7 % of EUC patients ( OR = 1.99 ; 95 % CI , 1.14 to 3.50 ; P = .02 ) . Intervention patients also experienced greater rates of depression treatment ( 72.3 % v 10.4 % of EUC patients ; P < .0001 ) and significantly better quality-of-life outcomes , including social/family ( adjusted mean difference between groups , 2.7 ; 95 % CI , 1.22 to 4.17 ; P < .001 ) , emotional ( adjusted mean difference , 1.29 ; 95 % CI , 0.26 to 2.22 ; P = .01 ) , functional ( adjusted mean difference , 1.34 ; 95 % CI , 0.08 to 2.59 ; P = .04 ) , and physical well-being ( adjusted mean difference , 2.79 ; 95 % CI , 0.49 to 5.1 ; P = .02 ) . CONCLUSION ADAPt-C collaborative care is feasible and results in significant reduction in depressive symptoms , improvement in quality of life , and lower pain levels compared with EUC for patients with depressive disorders in a low-income , predominantly Hispanic population in public sector oncology clinics .
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Intervention_Educational
collaborative care management of depression
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Intervention_Educational
Alleviating Depression Among Patients With
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Intervention_Other
Cancer ( ADAPt-C ) collaborative care management
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Intervention_Educational
intervention
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Intervention_Educational
enhanced usual care
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Intervention_Educational
access for up to 12 months to a depression clinical specialist ( supervised by a psychiatrist ) who offered education
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Intervention_Psychological
structured psychotherapy
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Intervention_Educational
maintenance/relapse prevention support
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Intervention_Pharmacological
antidepressant medications
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Intervention_Educational
ADAPt-C collaborative care
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Outcome_Mental
major depression
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Outcome_Mental
depressive symptoms
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Outcome_Other
Patient Health Questionnaire-9 ( PHQ-9 ) depression scale
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Outcome_Other
PHQ-9 score
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Outcome_Mental
greater rates of depression treatment
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Outcome_Other
better quality-of-life outcomes
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Outcome_Mental
emotional
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Outcome_Mental
physical well-being
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Participant_Condition
depression among low-income patients with cancer .
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Participant_Condition
Patients With Cancer