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Randomized Controlled Trial of Collaborative Care Management of Depression Among Low-Income Patients With Cancer

Kathleen Ell, Bin Xie, Brenda Quon, David I. Quinn, Megan Dwight-Johnson, Pey-Jiuan Lee

From the School of Social Work and Keck School of Medicine, University of Southern California, Los Angeles, CA; and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA

Corresponding author: Kathleen Ell, DSW, University of Southern California, School of Social Work, MRF 102R (MC 0411), Los Angeles, CA 90089-0411; e-mail: ell{at}usc.edu

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 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.

Supported by Grant No. R01CA105269 (K.E.) from the National Cancer Institute, Office of Cancer Survivorship, Bethesda, MD.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical trial information can be found for the following: NCT00565110 [ClinicalTrials.gov] .

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