The Indiana Cancer Pain and Depression (INCPAD) trial Design of a telecare management intervention for cancer-related symptoms and baseline characteristics of study participants.
OBJECTIVE
Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20-30% of oncology patients. Both symptoms are frequently either unrecognized or undertreated, however. This article describes a telecare management intervention delivered by a nurse-psychiatrist team that is designed to improve recognition and treatment of pain and depression. The enrolled sample is also described.


METHODS
The Indiana Cancer Pain and Depression study is a National Cancer Institute-sponsored randomized clinical trial. Four hundred five patients with cancer-related pain and/or clinically significant depression from 16 urban or rural oncology practices throughout Indiana have been enrolled and randomized to either the intervention group or to a usual-care control group. Intervention patients receive centralized telecare management coupled with automated home-based symptom monitoring. Outcomes will be assessed at 1, 3, 6 and 12 months by research assistants blinded to treatment arms.


RESULTS
Of 4465 patients screened, 2185 (49%) endorsed symptoms of pain or depression. Of screen-positive patients, about one-third were ineligible (most commonly due to pain or depression not meeting severity thresholds or to pain that is not related to cancer). Of the 405 patients enrolled, 32% have depression only, 24% have pain only and 44% have both depression and pain. At baseline, participants reported an average of 16.8 days out of the past 4 weeks during which they were confined to bed or had to reduce their usual activities by > or =50% due to pain or depression. Also, 176 (44%) reported being unable to work due to health reasons.


CONCLUSIONS
When completed, the Indiana Cancer Pain and Depression trial will test whether centralized telecare management coupled with automated home-based symptom monitoring improves outcomes in cancer patients with depression and/or pain. Findings will be important for both oncologists and mental health clinicians confronted with oncology patients' depression or pain.
Kroenke
Kurt
K
Department of Medicine, Indiana University, Indianapolis, IN 46202, USA. kkroenke@regenstrief.org
Theobald
Dale
D
Norton
Kelli
K
Sanders
Rebecca
R
Schlundt
Susan
S
McCalley
Stephanie
S
Harvey
Pamela
P
Iseminger
Karen
K
Morrison
Gwendolyn
G
Carpenter
Janet S
JS
Stubbs
Dawana
D
Jacks
Rakeva
R
Carney-Doebbeling
Caroline
C
Wu
Jingwei
J
Tu
Wanzhu
W
D000700:Analgesics / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D059408:Pain Management; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
D000700:Analgesics; D000928:Antidepressive Agents