Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized, controlled trial

Anne-Marie H Krebber, F Jansen, B I Witte, P Cuijpers, R. Bree, A. Becker-Commissaris, E F Smit, A van Straten, A.M. Eeckhout, A T F Beekman, C René Leemans, I M Verdonck-de Leeuw

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

BACKGROUND: This study aimed to evaluate the efficacy of stepped care (SC) targeting psychological distress in head and neck cancer (HNC) and lung cancer (LC) patients.

PATIENTS AND METHODS: Patients with untreated distress [Hospital Anxiety and Depression Scale (HADS; HADS-D > 7, HADS-A > 7, or HADS-total > 14)] were randomized to SC (n = 75) or care-as-usual (CAU) (n = 81). SC consisted of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy and/or psychotropic medication. The primary outcome measure was the HADS; secondary outcome measures were recovery rate, EORTC QLQ-C30, QLQ-HN35/QLQ-LC13, and IN-PATSAT32. Measures were assessed at baseline, after completion of care, and at 3, 6, 9, and 12 months follow-up. Linear mixed models, t-tests, and effect sizes (ES) were used to assess group differences.

RESULTS: Patients with untreated distress were randomized to SC (n = 75) or care-as-usual (CAU) (n = 81). The course of psychological distress was better after SC compared with CAU (HADS-total, P = 0.005; HADS-A, P = 0.046; HADS-D, P = 0.007). The SC group scored better post-treatment (HADS-total, ES = 0.56; HADS-A, ES = 0.38; HADS-D, ES = 0.64) and at 9 months follow-up (HADS-total, ES = 0.42 and HADS-A, ES = 0.40). The recovery rate post-treatment was 55% after SC compared with 29% after CAU (P = 0.002), and 46% and 37% at 12 months follow-up (P = 0.35). Within SC, 28% recovered after watchful waiting, 34% after guided self-help, 9% after problem-solving therapy, and 17% after psychotherapy and/or psychotropic medication. The effect of SC was stronger for patients with a depressive or anxiety disorder compared with patients without such a disorder (HADS-total, P = 0.001; HADS-A, P = 0.003; HADS-D, P = 0.041).

CONCLUSIONS: SC is effective and speeds up recovery among HNC and LC patients with untreated psychological distress.

TRIAL REGISTRATION: Netherlands Trial Register (NTR1868).

Original languageEnglish
Pages (from-to)1754-60
Number of pages7
JournalAnnals of Oncology
Volume27
Issue number9
DOIs
Publication statusPublished - Sep 2016

Keywords

  • Journal Article

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