Oncology Depression Program--Latinas with Cancer

University Of Southern California, Los Angeles CA

Investigators

Linked publications & trials

Abstract

DESCRIPTION (Provided by applicant): Despite the high incidence of depression among patients with cancer, detection and treatment of depression in oncology care is inadequate with negative effects on patient's functioning, symptoms, quality of life, and even survival. Hispanics under-utilize mental health services and have been underrepresented in depression treatment studies. We propose to conduct a phased developmental pilot study of a socioculturally compatible Multifaceted Oncology Depression Program (MODP). MODP is aimed at reducing symptoms and improving outcomes among Latinas with breast or cervical cancer, reducing demands on family caregivers, and assisting oncologists in caring for their patients. Thus, we aim to: 1) Adapt an existing collaborative care model used in primary care, implement the model, evaluate and further refine the model based on the pilot experience, and produce a detailed manual for use in a randomized trial; 2) determine what treatment is given and what outcomes are obtained with usual care for recognized depression in a separate open trial; 3) evaluate the MODP in an open trial to determine its acceptance by patients and oncologists, adherence, and the size and variability of change from baseline in the primary outcome measures: depressive symptoms, quality of life, and caregiver distress at 4 and 8 months follow-up; 4) estimate the proportion of oncology outpatients having major depression who would meet eligibility criteria for a randomized study; 5) evaluate the use of assessment and outcome measures including direct cost measures; and (6) determine what additional cultural adaptations are needed to optimize acceptance and outcomes of treatment for a low-income Hispanic patient population. The proposed study will address the following specific questions: (i) Can a collaborative model of depression care known to be effective in primary care be effectively adapted and implemented in specialty oncology care, and specifically among low-income Hispanic patients? (ii) What modifications in the intervention model are acceptable, feasible, and appropriate for oncology practice and for Hispanic women? (iii) By implementing enhanced depression management with socioculturally compatible interventions to reduce known barriers to Latinas' access to depression treatment, will recruitment, retention, follow-up, and outcomes of minority women be favorably affected versus modestly augmented usual care? (iv) What would be likely recruitment, necessary sample size and best measures for a randomized trial to compare the effectiveness of the MODP and usual care for patients with identified major depression? Two open trials (of usual care and MODP) will be carried out sequentially on 40 women (a total of 80 women). Women will be screened using the SCL-20 and diagnostically assessed using the PRIME-MD PHQ-9. In addition to screening and physician didactics, MODP intervention enhancements are: onsite case management services to reduce barriers to care; patient and family education on depression treatment; psychiatric consultation; and patient-oncologist shared decision-making in selecting medication treatment or cognitive-behavioral Problem-Solving Treatment.