Stepped Care Targeting Psychological Distress in Head and Neck Cancer and Lung Cancer Patients: a Randomized Controlled Trial
Mené aux Pays-Bas auprès de 156 patients atteints d'un cancer de la tête et du cou ou d'un cancer du poumon, cet essai randomisé évalue l'efficacité d'une approche progressive de prise en charge de leur détresse psychologique
Background : This study aimed to evaluate the efficacy of stepped care (SC) targeting psychological distress in head and neck cancer (HNC) and lung cancer (LC) patients. Patients and methods : Patients with untreated distress (Hospital Anxiety and Depression Scale (HADS; HADS-D>7, HADS-A>7, or HADS-total>14)) were randomized to SC (n=75) or care-as-usual (CAU) (n=81). SC consisted of watchful waiting, guided self-help, problem solving therapy, and psychotherapy and/or psychotropic medication. Primary outcome measure was the HADS, secondary outcome measures were recovery rate, EORTC QLQ-C30, QLQ-HN35/QLQ-LC13, and IN-PATSAT32. Measures were assessed at baseline, after completion of care, and at three, six, nine and 12 months follow-up. Linear mixed models, t-tests and effect sizes (ES) were used to assess group differences. Results : Patients with untreated distress were randomized to SC (n=75) or care-as-usual (CAU) (n=81). The course of psychological distress was better after SC compared to CAU (HADS-total, p=·005; HADS-A, p=·046; HADS-D, p=·007). The SC group scored better post-treatment (HADS-total, ES=·56; HADS-A, ES=·38; HADS-D, ES=·64) and at 9 months follow-up (HADS-total, ES=·42 and HADS-A, ES=·40). Recovery rate post-treatment was 55% after SC compared to 29% after CAU (p=·002), and 46% and 37% at 12 months follow-up (p=·35). Within SC, 28% recovered after watchful waiting, 34% after guided self-help, 9% after problem solving therapy, and 17% after psychotherapy and/or psychotropic medication. The effect of SC was stronger for patients with a depressive or anxiety disorder compared to patients without such a disorder (HADS-total, p=·001; HADS-A, p=·003; HADS-D, p=·041). Conclusion(s) : SC is effective and speeds up recovery among HNC and LC patients with untreated psychological distress.Trial registration Netherlands Trial Register (NTR1868)