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Blogger's Note: full access requires $$ however charts 1-5 are available for viewing: A stepped web-based collaborative care intervention reduces symptoms, improves quality of life, and decreases inflammation for patients receiving palliative care for cancer. Furthermore, the intervention reduces caregiver stress and depression.
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.
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