Improving primary care for older adults with cancer and depression

J Gen Intern Med. 2009 Nov;24 Suppl 2(Suppl 2):S417-24. doi: 10.1007/s11606-009-0999-4.

Abstract

Background: Depression is common among older cancer patients, but little is known about the optimal approach to caring for this population. This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program, a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis.

Methods: Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study. Subjects were 60 years or older with major depression (18%), dysthymic disorder (33%), or both (49%), recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states. Patients were randomly assigned to the IMPACT intervention (n = 112) or usual care (n = 103). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education, care management, support of antidepressant management, and brief, structured psychosocial interventions including behavioral activation and problem-solving treatment.

Results: At 6 and 12 months, 55% and 39% of intervention patients had a 50% or greater reduction in depressive symptoms (SCL-20) from baseline compared to 34% and 20% of usual care participants (P = 0.003 and P = 0.029). Intervention patients also experienced greater remission rates (P = 0.031), more depression-free days (P < 0.001), less functional impairment (P = 0.011), and greater quality of life (P = 0.039) at 12 months than usual care participants.

Conclusions: The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care settings.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Age Factors
  • Aged
  • Cohort Studies
  • Depressive Disorder / etiology
  • Depressive Disorder / psychology*
  • Depressive Disorder / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Neoplasms / complications
  • Neoplasms / psychology*
  • Neoplasms / therapy*
  • Primary Health Care / methods
  • Primary Health Care / trends*
  • Quality of Life / psychology
  • Treatment Outcome