Originally published as JCO Early Release 10.1200/JCO.2009.22.8718 on November 16 2009

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Impact of Two Supportive Care Interventions on Anxiety, Depression, Quality of Life, and Unmet Needs in Patients With Nonlocalized Breast and Colorectal Cancers

From the Centre for Health Research and Psycho-oncology, Cancer Council New South Wales, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales; and Department of Nursing and Supportive Care Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

Corresponding author: Afaf Girgis, PhD, Centre for Health Research and Psycho-oncology, Cancer Council New South Wales, University of Newcastle and Hunter Medical Research Institute, Level 2, David Maddison Building, University of Newcastle, Callaghan, New South Wales 2308, Australia; e-mail: afaf.girgis{at}newcastle.edu.au.

Purpose Patients with cancer experience considerable symptom burden, psychological morbidity, and unmet psychosocial needs. Research suggests that feedback of patient-reported outcomes to clinicians or caseworkers, alongside management strategies, may result in improved patient functioning. Two intervention models were developed to test this effect in a randomized, controlled trial against usual care (UC): a telephone caseworker (TCW) model and an oncologist/general practitioner (O/GP) model. Primary end points included anxiety, depression, physical/emotional functioning, and unmet supportive care needs.

Patients and Methods Participants with nonlocalized breast or colorectal cancers were surveyed by computer-assisted telephone interview (CATI) at three time points: baseline, 3 months, and 6 months. Data collected from participant CATIs in the supportive care models were used to generate feedback to either each participant's designated TCW, or their nominated O/GPs. Data obtained from participants in the UC model were used only to assess the impact of supportive care models. In total, 356 participants consented to study participation, completed the baseline CATI, and were randomly assigned to the UC, TCW, or O/GP groups.

Results No overall intervention effect was observed. Physical functioning was significantly improved at the third CATI for participants in the TCW model (P = .01), and there was a trend toward fewer participants with unmet needs (P = .07). TCW group participants also were more likely to have the following: identified issues of need discussed (P < .0001); referrals made (P < .0001); and strong agreement that the intervention improved communication with their health care team (P = .0005).

Conclusion The TCW model holds some promise; however, additional work in at-risk populations is required before we recommend implementation.

Supported by the National Health and Medical Research Council of Australia Palliative Care Research Grant No. 300807; by the Medical Benefits Fund of Australia; and by infrastructure support from the Hunter Medical Research Institute.

The views expressed are not necessarily those of the Cancer Council.

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

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