Reducing Cancer Pain and Depression

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Pain and depression associated with cancer, symptoms often unrecognized and under-treated, can be significantly reduced through centralized telephone-based care management coupled with automated symptom monitoring, according to researchers from the Regenstrief Institute and Indiana University School of Medicine.

The Indiana Cancer Pain and Depression (INCPAD) study combined automated calls with follow-up calls from the nurse care manager to reduce pain and depression in cancer patients. Calls were made to individuals with all types of cancers seen by rural and urban community-based oncology physicians.

The improved outcomes of the patients who received the telephone-based care management and the feasibility of this approach is reported in the July 14, 2010, issue of the Journal of American Medical Association (JAMA).

"Because oncologists are busy with testing, chemotherapy and other treatments, they often have too little time left for quality of life issues, like pain and depression. We felt one solution might be a partnership between a telephone-based symptom management team and community-based oncology practices. We found that an economical, centralized approach is feasible to conduct and significantly improved symptoms of both depression and pain in patients in any phase of cancer from newly diagnosed to long term to recurrent to cancer free," said Kurt Kroenke, M.D., the study's principal investigator. Dr. Kroenke is a Regenstrief Institute investigator and an IU School of Medicine professor of medicine.

An INCPAD nurse manager reviewed the data collected from the automated symptom monitoring phone calls that, for example, instructed the patients to rate their depression and pain on scales of 1 to 10. This data allowed the nurse's phone contacts to be more efficient by targeting areas needing attention. Although most study participants, whose average age was 59, elected automated surveillance calls, they also were offered an option to participate online in this aspect of the study.

"Technology, in the form of automated calls repeated until an adequate treatment response occurred, allowed us to gather data on symptom severity at a time convenient for the patient, making the process very patient-centered. It also allowed the nurse manager to work at a higher level to improve the quality of life of these cancer patients. And it gave these patients, many of whom lived in underserved rural areas, one stop assistance they probably wouldn't have had access to unless they went to a major cancer center," said Dr. Kroenke, who is a research scientist with the Center for Implementing Evidence-Based Practice at the Richard Roudebush VA Medical Center and an Indiana University Melvin and Bren Simon Cancer Center member.

INCPAD enrolled 405 cancer patients, including 178 with both depression and pain, 131 with depression only and 96 with pain only. Patients who participated in the study were randomized to usual care or telephone-based case management.

In addition to Dr. Kroenke, co-authors of "Effect of Telecare Management on Pain and Depression in Patients with Cancer: A Randomized Trial," are Dale Theobald, M.D., of Community Cancer Care and the Community Health Network; Jingwei Wu, M.S., of the IU School of Medicine; Kelli Norton, B.S., of the Regenstrief Institute; Gwendolyn Morrison, Ph.D., of the Regenstrief Institute and the IU School of Liberal Arts; Janet Carpenter, Ph.D., R.N., of the IU School of Nursing; and Wanzhu Tu, Ph.D., of the Regenstrief Institute and the IU School of Medicine.

The study was supported by a grant from the National Cancer Institute.

The Regenstrief Institute, the IU Simon Cancer Center and the IU Schools of Medicine, Liberal Arts and Nursing are located on the campus of Indiana University-Purdue University Indianapolis.

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