title: Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting.
abstract: BACKGROUND
  The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life.
  
  
  METHODS
  A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression.
  
  
  RESULTS
  At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm.
  
  
  CONCLUSIONS
  The integration of screening and symptom management into cancer care is recommended.
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Departments of Medicine, Surgery and Immunology, Hillman Cancer Center, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Butterfield
authors.affiliation: School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Spring
authors.affiliation: School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grady
authors.affiliation: Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Weiing
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Wallis
authors.initials: W
authors.lastname: Marsh
authors.affiliation: Department of Psychology, University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida.
authors.forename: Michael
authors.initials: M
authors.lastname: Antoni
authors.affiliation: Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania.
authors.forename: Vicki
authors.initials: V
authors.lastname: Helgeson
authors.affiliation: Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D017028:Caregivers / Q000523:psychology*; D016009:Chi-Square Distribution; D059350:Chronic Pain / Q000517:prevention & control / Q000628:therapy; D003299:Cooperative Behavior; D003863:Depression / Q000517:prevention & control / Q000628:therapy; D019468:Disease Management; D005221:Fatigue / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care / Q000458:organization & administration*; D015397:Program Evaluation; D011788:Quality of Life; D018570:Risk Assessment; D013813:Therapy, Computer-Assisted / Q000458:organization & administration*; D016896:Treatment Outcome; D014481:United States
keywords: biobehavioral psychology oncology; collaborative care; depression; pain; quality of life