Associate Professor Suzanne Chambers
Dr Stefano Occhipinti
Dr Jane Turner
Professor Robert C Carter
Professor Jeffrey K Dunn
Ms Sandy Hutchison
Ms Paula Vallentine
Ms Wendy Reid
Associate Professor Martin Stockier
Ms Megan Dwyer
Cancer Council Queensland
$270,142 from beyondblue – Total funding $540, 284
Priority-driven Collaborative Cancer Research Scheme (PdCCRS)
Project completion year
The aim of the proposed study was to assess the efficacy and cost-effectiveness of accessible and affordable psychological interventions for distressed cancer patients and carers who contact community based Cancer Helplines. The study comprised a randomised controlled trial with patients and carers who had elevated psychological distress, and compared minimal contact self management with an individualised tele-based cognitive behavioural intervention.
It was hypothesised that three, six and 12 months after recruitment:
- Participants in both study arms will experience significant improvements in mental health compared to baseline levels including: reduced anxiety and depression; cancer specific distress; unmet psychological supportive care needs; and increased positive adjustment and quality of life.
- Participants with borderline anxiety/depression who receive the minimal contact self management condition will experience significantly less anxiety and depression; less cancer specific distress; lower unmet psychological supportive care needs; higher positive adjustment and improved quality of life by comparison to participants with high anxiety/depression who receive the minimal contact self management condition.
- Participants with high anxiety/depression who receive the individualised tele-based cognitive behavioural intervention condition will experience significantly less anxiety and depression; less cancer specific distress; lower unmet psychological supportive care needs; higher positive adjustment and improved quality of life by comparison to participants with high anxiety/depression who receive the minimal contact self management condition.
- That from a health sector perspective, the individualised tele-based cognitive behavioural intervention is more 'cost-effective' compared to the minimal contact self management condition for high anxiety/depression participants, and minimal contact self management is more cost-effective than the individualised tele-based cognitive behavioural intervention for borderline anxiety/depression participants; where $50,000 per QAL Y is taken as the benchmark for cost-effectiveness in Australia.
Research findings and outcomes
Contrary to hypotheses, baseline initial distress did not have an effect on the efficacy of the Intervention for patients or carers. However, based on recent findings from related randomised controlled trial intervention studies, socio-demographic moderators were investigated as moderators of intervention effects.
For psychological distress as measured by the Brief Symptom Index-1S, the effect of the Intervention on the trajectory of distress for patients was associated with participant educational attainment. Specifically, for High Education participants, the Nurse and Psychologist Intervention were associated with a significant drop in distress over the 12 month time period. However, for Low Education participants, only the Psychologist Intervention was associated with a significant drop in distress whereas in the Nurse Intervention the trajectory of distress was flat. The trajectory of psychological distress decreased significantly over time for carers in the Nurse and Psychologist Interventions.
Cancer-specific distress decreased significantly and posttraumatic growth increased significantly over the study for both patients and carers. Socio-demographic variables, initial baseline distress, and the Intervention did not moderate the trajectory of cancer specific distress or posttraumatic growth.
Impact/potential impact of the research
Importantly, the findings of the present study demonstrate that while brief tele-based psychosocial interventions are effective at reducing psychological distress in cancer patients, patient characteristics play an important role in influencing the efficacy of the intervention. Specifically, this study has shown that educational attainment is a critical characteristic that influences how cancer patients respond to psychosocial interventions. Accordingly, these findings have implications for future intervention studies and should direct researchers to look specifically at tailoring psychosocial programs to participants who may have low health literacy.
Further, the finding that a brief tele-based psychological intervention was effective in decreasing anxiety and depression in cancer patients clearly has potential benefits for delivering a low-cost service that can be broadly disseminated through state-based cancer helplines and other telephone support services.