Screening and Stepped Care Targeting Psychological Distress in Patients With Metastatic Colorectal Cancer: The TES Cluster Randomized Trial.

Autor:	Schuurhuizen CSEW; Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam.; Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam., Braamse AMJ; Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Institute, Academic Medical Center, Amsterdam., Beekman ATF; Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam., Cuijpers P; Department of Clinical Psychology, VU University, Amsterdam., van der Linden MHM; Department of Medical Psychology, and., Hoogendoorn AW; Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam., Berkhof H; Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam., Sommeijer DW; Department of Medical Oncology, Flevoziekenhuis, Almere., Lustig V; Department of Medical Oncology, Flevoziekenhuis, Almere., Vrijaldenhoven S; Department of Medical Oncology, Noordwest Ziekenhuisgroep, Alkmaar., Bloemendal HJ; Department of Medical Oncology, Meander Medical Center, Amersfoort., van Groeningen CJ; Department of Medical Oncology, Hospital Amstelland, Amstelveen., van Zweeden AA; Department of Medical Oncology, Hospital Amstelland, Amstelveen., van der Vorst MJDL; Department of Medical Oncology, Rijnstate Hospital, Arnhem., Rietbroek R; Department of Medical Oncology, Red Cross Hospital, Beverwijk., Tromp-van Driel CS; Department of Medical Oncology, Noordwest Ziekenhuisgroep, Den Helder., Wymenga MNW; Department of Medical Oncology, Medisch Spectrum Twente, Enschede., van der Linden PW; Department of Medical Oncology, Spaarne Gasthuis, Haarlem., Beeker A; Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp., Polee MB; Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden., Batman E; Department of Medical Oncology, Alrijne Hospital, Leiden., Los M; Department of Medical Oncology, St. Antonius Hospital, Nieuwegein., van Bochove A; Department of Medical Oncology, Zaans Medical Center, Zaandam; and., Brakenhoff JAC; Department of Medical Oncology, Waterland Hospital, Purmerend, the Netherlands., Konings IRHM; Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam., Verheul HMW; Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam., Dekker J; Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam.
Jazyk:	angličtina
Zdroj:	Journal of the National Comprehensive Cancer Network : JNCCN [J Natl Compr Canc Netw] 2019 Aug 01; Vol. 17 (8), pp. 911-920.
DOI:	10.6004/jnccn.2019.7285
Abstrakt:	Background: This study evaluated the effectiveness of a screening and stepped care program (the TES program) in reducing psychological distress compared with care as usual (CAU) in patients with metastatic colorectal cancer starting with first-line systemic palliative treatment. Patients and Methods: In this cluster randomized trial, 16 hospitals were assigned to the TES program or CAU. Patients in the TES arm were screened for psychological distress with the Hospital Anxiety and Depression Scale and the Distress Thermometer/Problem List (at baseline and 10 and 18 weeks). Stepped care was offered to patients with distress or expressed needs, and it consisted of watchful waiting, guided self-help, face-to-face problem-solving therapy, or referral to specialized mental healthcare. The primary outcome was change in psychological distress over time, and secondary outcomes were quality of life, satisfaction with care, and recognition and referral of distressed patients by clinicians. Linear mixed models and effect sizes were used to evaluate differences. Results: A total of 349 patients were randomized; 184 received the TES program and 165 received CAU. In the TES arm, 60.3% of the patients screened positive for psychological distress, 26.1% of which entered the stepped care program (14.7% used only watchful waiting and 11.4% used at least one of the other treatment steps). The observed low use of the TES program led us to pursue a futility analysis, which showed a small conditional power and therefore resulted in halted recruitment for this study. No difference was seen in change in psychological distress over time between the 2 groups (effect size, -0.16; 95% CI, -0.35 to 0.03; P>.05). The TES group reported higher satisfaction with the received treatment and better cognitive quality of life (all P<.05). Conclusions: As a result of the low use of stepped care, a combined screening and treatment program targeting psychological distress in patients with metastatic colorectal cancer did not improve psychological distress. Our results suggest that enhanced evaluation of psychosocial concerns may improve aspects of patient well-being.
Databáze:	MEDLINE
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