Patient, family caregiver, and economic outcomes of an integrated screening and novel stepped collaborative care intervention in the oncology setting in the USA (CARES): a randomised, parallel, phase 3 trial.

Autor:	Steel JL; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: steejl@upmc.edu., George CJ; School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA., Terhorst L; School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA., Yabes JG; Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA., Reyes V; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Zandberg DP; Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Nilsen M; Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA., Kiefer G; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Johnson J; Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Marsh C; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Bierenbaum J; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Tageja N; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Krauze M; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., VanderWeele R; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Goel G; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Ramineni G; UPMC Hillman Cancer Center, Pittsburgh, PA, USA., Antoni M; Department of Psychology, Sylvester Cancer Center, University of Miami, FL, USA., Vodovotz Y; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA., Walker J; School of Information Sciences, University of Pittsburgh, Pittsburgh, PA, USA., Tohme S; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Billiar T; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Geller DA; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Jazyk:	angličtina
Zdroj:	Lancet (London, England) [Lancet] 2024 Apr 06; Vol. 403 (10434), pp. 1351-1361. Date of Electronic Publication: 2024 Mar 12.
DOI:	10.1016/S0140-6736(24)00015-1
Abstrakt:	Background: The current standard of care of screening and referring patients for treatment for symptoms, such as depression, pain, and fatigue, is not effective. This trial aimed to test the efficacy of an integrated screening and novel stepped collaborative care intervention versus standard of care for patients with cancer and at least one of the following symptoms: depression, pain, or fatigue. Methods: This randomised, parallel, phase 3 trial was conducted in 29 oncology outpatient clinics associated with the UPMC Hillman Cancer Center in the USA. Patients (aged ≥21 years) with any cancer type and clinical levels of depression, pain, or fatigue (or all of these) were eligible. Eligible family caregivers were aged 21 years or older and providing care to a patient diagnosed with cancer who consented for this study. Patients were randomly assigned (1:1) to stepped collaborative care or standard of care using a central, permuted block design (sizes of 2, 4, and 6) stratified by sex and prognostic status. The biostatistician, oncologists, and outcome assessors were masked to treatment assignment. Stepped collaborative care was once-weekly cognitive behavioural therapy for 50-60 min from a care coordinator via telemedicine (eg, telephone or videoconferencing). Pharmacotherapy for symptoms might be initiated or changed if recommended by the treatment team or preferred by the patient. Standard of care was screening and referral to a health-care provider for treatment of symptoms. The primary outcome was health-related quality of life in patients at 6 months. Maintenance of the treatment benefits was assessed at 12 months. Participants included in the primary analysis were per intention to treat, which included patients missing one or both follow-up assessments. This trial was registered with ClinicalTrials.gov (NCT02939755). Findings: Between Dec 5, 2016, and April 8, 2021, 459 patients and 190 family caregivers were enrolled. 222 patients were assigned to standard of care and 237 to stepped collaborative care. Of 459 patients, 201 (44%) were male and 258 (56%) were female. Patients in the stepped collaborative care group had a greater 0-6-month improvement in health-related quality of life than patients in the standard-of-care group (p=0·013, effect size 0·09). Health-related quality of life was maintained for the stepped collaborative care group (p=0·74, effect size 0·01). Patients in the stepped collaborative care group had greater 0-6-month improvements than the standard-of-care group in emotional (p=0·012), functional (p=0·042), and physical (p=0·033) wellbeing. No adverse events were reported by patients in either group and deaths were considered unrelated to the study. Interpretation: An integrated screening and novel stepped collaborative care intervention, compared with the current standard of care, is recommended to improve health-related quality of life. The findings of this study will advance the implementation of guideline concordant care (screening and treatment) and has the potential to shift the practice of screening and treatment paradigm nationwide, improving outcomes for patients diagnosed with cancer. Funding: US National Cancer Institute. Competing Interests: Declaration of interests JLS receives royalties from Springer for the books Living Donor Advocacy and Psychological Aspects of Cancer. JGY's institution received funding from the US National Institutes of Health, Agency for Healthcare Research and Quality, and Bayer. DPZ receives consulting fees from Merck, Macrogenics, Seagen, and GlaxoSmithKline. GK is on the board of Ganga Prem Hospice. MA receives royalties from Pearson, the American Psychological Association, and Oxford Press and consulting fees from Blue Note Therapeutics and Atlantis Healthcare. YV is a co-founder and member of the Board of Directors of the Society for Complex Acute Illness and a co-founder of and has founder shares in Immunetrics. TB has received support for attending the Shock Society's annual meeting, serves on the board of RiMed, has founders shares in Immunetrics, and holds US patents (ie, 5,468,630; 5,658,565; 5,714,511; 5,830,461; 5,882,908; 6,103,230; 6,424,804; 11,179,412). (Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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