JAMA logoSuccessfully overcoming cancer is a huge victory and every cancer survivor has his own tale to tell. But in the course of defeating the ailment, another issue that may arise is providing the required care and attention. Experts suggest that cancer patients receiving care in geographically dispersed urban and rural oncology practices subjected to telephone-based care management and home-based automated symptom supposedly display better improvement in pain and depression as compared to patients acquiring usual care.

Even though pain and depression seem to be the most usual physical and psychological symptoms in cancer patients, these symptoms often remain undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial was triggered in 16 community-based urban and rural geographically dispersed oncology practices, as a co-operative care approach to manage depression and pain.

The trial commenced from March 2006 through August 2008 and the follow-up ended in August 2009. In the event of the study, the scientists randomly assigned study subjects with depression, cancer-related pain, or both and were stratified by symptom type . While around 202 received the intervention, 203 were provided with general care.

The investigators remarked, “Our INCPAD trial has several important findings. First, the telecare management intervention resulted in significant improvements in both pain and depression. Second, the trial demonstrated that it is feasible to provide telephone-based centralized symptom management across multiple geographically dispersed community-based practices in both urban and rural areas by coupling human with technology-augmented patient interactions. Third, the findings did not appear to be confounded by differential rates of co-interventions or health care use.”

Kurt Kroenke, M.D., of the Richard Roudebush VA Medical Center, Indiana University, and Regenstrief Institute, Indianapolis, and colleagues revealed that patients belonging to the intervention group were provided with telecare management by a nurse-physician specialist team. These patients were also given automated home-based symptom monitoring by interactive voice recording or Internet.

A nurse care manager trained in assessing symptom response and medication adherence discharged the telephonic care management and gave pain and depression-specific education. Keeping in mind the evidence-based guidelines, treatment adjustments were also made. On the onset of the trail and at the 1,3,6, and 12 months of the investigation, symptoms of pain and depression were evaluated. Amongst the total 405 study participants, 131 reported depression alone, 96 revealed pain only and 178 had both depression and pain.

After the completion of 12 months of the study, the experts observed that among 274 patients with pain, 137 patients in the intervention group had greater improvements in pain severity as determined by the Brief Pain Inventory wherein the BPI was 30 percent or greater decrease in BPI. However, satisfactory results were noted in the 137 patients from the usual-care group.

The authors conclude, “The fact that INCPAD was beneficial for the most common physical and psychological symptoms in cancer patients demonstrates that a collaborative care intervention can cover several conditions, both physical and psychological.”

In the intervention group, of the 309 patients with depression, the 154 patients supposedly registered greater improvement in depression severity as assessed by the Hopkins Symptom Checklist HSCL with 50 percent or greater decrease in HSCL than the 155 patients in the usual-care group. The authors claim differences in secondary outcomes between-group differences were not in pain or depression.

After evaluating specific and the intervention group, the investigators mention that the patients from the intervention group displayed better outcomes for several health-related quality of life domains, including mental health, vitality, anxiety, and physical symptom burden.

The study is published in the July 14 issue of JAMA.