Randomized controlled trial of collaborative care management of depression among low-income patients with cancer.
OBJECTIVE
To determine the effectiveness of the Alleviating Depression Among Patients With Cancer (ADAPt-C) collaborative care management for major depression or dysthymia.


METHODS
Study patients included 472 low-income, predominantly female Hispanic patients with cancer age >or= 18 years with major depression (49%), dysthymia (5%), or both (46%). Patients were randomly assigned to intervention (n = 242) or enhanced usual care (EUC; n = 230). Intervention patients had access for up to 12 months to a depression clinical specialist (supervised by a psychiatrist) who offered education, structured psychotherapy, and maintenance/relapse prevention support. The psychiatrist prescribed antidepressant medications for patients preferring or assessed to require medication.


RESULTS
At 12 months, 63% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline as assessed by the Patient Health Questionnaire-9 (PHQ-9) depression scale compared with 50% of EUC patients (odds ratio [OR] = 1.98; 95% CI, 1.16 to 3.38; P = .01). Improvement was also found for 5-point decrease in PHQ-9 score among 72.2% of intervention patients compared with 59.7% of EUC patients (OR = 1.99; 95% CI, 1.14 to 3.50; P = .02). Intervention patients also experienced greater rates of depression treatment (72.3% v 10.4% of EUC patients; P < .0001) and significantly better quality-of-life outcomes, including social/family (adjusted mean difference between groups, 2.7; 95% CI, 1.22 to 4.17; P < .001), emotional (adjusted mean difference, 1.29; 95% CI, 0.26 to 2.22; P = .01), functional (adjusted mean difference, 1.34; 95% CI, 0.08 to 2.59; P = .04), and physical well-being (adjusted mean difference, 2.79; 95% CI, 0.49 to 5.1; P = .02).


CONCLUSIONS
ADAPt-C collaborative care is feasible and results in significant reduction in depressive symptoms, improvement in quality of life, and lower pain levels compared with EUC for patients with depressive disorders in a low-income, predominantly Hispanic population in public sector oncology clinics.
Ell
Kathleen
K
School of Social Work and Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-0411, USA. ell@usc.edu
Xie
Bin
B
Quon
Brenda
B
Quinn
David I
DI
Dwight-Johnson
Megan
M
Lee
Pey-Jiuan
PJ
D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000208:ethnology / Q000209:etiology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000208:ethnology / Q000209:etiology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D009369:Neoplasms / Q000150:complications*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D011613:Psychotherapy; D011788:Quality of Life; D017678:Sex Distribution; D012959:Socioeconomic Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents
Prim Care Companion J Clin Psychiatry. 2007;9(5):382-7
17998958
J Affect Disord. 2007 Apr;99(1-3):139-45
17049999
J Gen Intern Med. 2001 Sep;16(9):606-13
11556941
Psychosomatics. 2006 Jan-Feb;47(1):62-7
16384809
Cancer. 1998 Oct 15;83(8):1640-51
9781960
Psychiatr Serv. 2007 Aug;58(8):1057-64
17664516
JAMA. 1999 Nov 10;282(18):1737-44
10568646
J Am Geriatr Soc. 2004 Jan;52(1):106-11
14687323
Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):1105-12
9869236
Br J Cancer. 2004 Jan 26;90(2):310-3
14735169
J Clin Oncol. 2005 Sep 1;23(25):6063-71
16087949
Cancer. 2007 Oct 15;110(8):1665-76
17847017
Prev Med. 2007 Jan;44(1):26-33
16962652
JAMA. 2002 Dec 11;288(22):2836-45
12472325
Ann Fam Med. 2004 Sep-Oct;2(5):398-404
15506570
Support Care Cancer. 2003 May;11(5):278-85
12720073
Gen Hosp Psychiatry. 1998 Jul;20(4):241-7
9719904
Med Care. 2004 Dec;42(12):1194-201
15550799
Psychosomatics. 2005 May-Jun;46(3):224-32
15883143
Breast Cancer Res Treat. 2001 Jun;67(3):255-62
11561771
Cancer. 1984 May 1;53(9):2002-7
6704925
Psychosomatics. 2003 Jan-Feb;44(1):24-30
12515834
Med Care. 1992 Jun;30(6):473-83
1593914
J Am Geriatr Soc. 2003 Dec;51(12):1808-9
14687363
Cancer. 2002 Jun 15;94(12):3089-100
12115339
Psychol Assess. 2007 Jun;19(2):247-51
17563207
J Gen Intern Med. 2006 Jun;21(6):547-52
16808734
JAMA. 2003 Jul 2;290(1):57-65
12837712
J Gen Intern Med. 1997 Jul;12(7):431-8
9229282
J Adv Nurs. 2004 Jan;45(2):205-13
14706006
Oncol Nurs Forum. 1999 Apr;26(3):593-9
10214600
Gen Hosp Psychiatry. 2007 Nov-Dec;29(6):547-54
18022048
J Clin Oncol. 1993 Mar;11(3):570-9
8445433
Gen Hosp Psychiatry. 2007 Sep-Oct;29(5):388-95
17888804
J Natl Cancer Inst Monogr. 2004;(32):57-71
15263042
Psychother Psychosom. 2004 Nov-Dec;73(6):386-90
15479995
J Clin Oncol. 1998 Apr;16(4):1594-600
9552071
Br J Cancer. 2006 Feb 13;94(3):372-90
16465173
Gen Hosp Psychiatry. 2007 May-Jun;29(3):223-31
17484939
J Clin Oncol. 2002 Dec 1;20(23):4581-90
12454116
J Clin Oncol. 2005 May 1;23(13):3052-60
15860863
Curr Oncol. 2007 Oct;14(5):180-8
17938701
J Affect Disord. 2004 Jul;81(1):61-6
15183601
Arch Gen Psychiatry. 2001 Mar;58(3):241-7
11231831
Psychosom Med. 2003 Jul-Aug;65(4):636-43
12883115
J Adv Nurs. 2004 Jun;46(5):542-8
15139943
Br J Cancer. 2004 Jan 26;90(2):314-20
14735170
Br J Cancer. 2001 Apr 20;84(8):1011-5
11308246
J Natl Cancer Inst Monogr. 2004;(32):32-9
15263039
JAMA. 2004 Aug 25;292(8):935-42
15328325
Med Care. 1998 Sep;36(9):1407-18
9749663
Health Serv Res. 2003 Apr;38(2):613-30
12785564
Cancer. 2008 Feb 1;112(3):616-25
18085642
Psychother Psychosom. 2004 Jul-Aug;73(4):235-42
15184718
J Gen Intern Med. 2000 Aug;15(8):527-34
10940143
Br J Gen Pract. 2008 Jan;58(546):32-6
18186994
J Affect Disord. 2004 Feb;78(2):131-40
14706723
Cancer Pract. 1997 Jul-Aug;5(4):241-6
9250081