Supportive telephone intervention for patients receiving chemotherapy. A pilot study

Telephone consultation for cancer survivors with unclarified need for rehabilitation in a primary healthcare setting: a mixed methods process evaluation

PURPOSE

To evaluate the implementation of telephone consultations to assess cancer patients' needs for rehabilitation, with focus on patients' acceptance, health professionals' experience and contextual factors.

METHODS

A mixed methods process evaluation was conducted at a primary healthcare rehabilitation clinic. Cancer survivors above 18 years of age with an unclarified rehabilitation need at discharge from hospital, was offered a telephone consultation provided by health professionals. Data on implementation and acceptability were collected using medical records systems, data collection forms and semi-structured interviews with six patients and two health professionals.

RESULTS

Eighty-one cancer survivors were referred to the intervention, and 54% continued to further rehabilitation. The telephone consultations were executed approximately eight days after referral and took on average 44 min to deliver. Overall, the patients found that the telephone consultation addressed what they considered the most important topics, and the health professionals found the intervention to be acceptable. Both patients and health professionals reported challenges regarding the referral process.

CONCLUSION

Patient acceptance of the intervention was high, and the telephone consultation was implemented to a high degree, resulting in more than half of the patients continuing to further rehabilitation. Patients' and health professionals' perspectives provided valuable insights about contextual factors.

The extent of engagement with telehealth approaches by patients with advanced cancer: A systematic review (Preprint)

Background

Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear.

Objective

The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature.

Methods

This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies.

Results

Of the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery.

Conclusions

Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care.

Trial Registration

PROSPERO (International Prospective Register of Systematic Reviews) CRD42018117232; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018117232

Personalized Prechemotherapy Education Reduces Peri-Chemotherapy Anxiety in Colorectal Cancer Patients

Objective

To evaluate the effect of personalized prechemotherapy education in the reduction of peri-chemotherapy anxiety in patients with colorectal cancer.

Methods

Patients admitted to the Department of Oncology with a diagnosis of stage III or IV colorectal cancer and scheduled for initial chemotherapy from January 1, 2017, to June 30, 2019, were retrieved. Patients in the educated group completed the GAD-7 form to evaluate their anxiety level at admission and 14 days after personalized prechemotherapy education, the educator team of which included both physician and nurse staff. Patients in the control group only completed GAD-7 forms at admission and 14 days thereafter without personalized education.

Results

Three hundred and sixty-four patients were enrolled for analysis, including 127 patients who received personalized prechemotherapy education and 237 patients who did not receive education. There were no significant differences in age, gender, education level, or pretreatment GAD-7 scores between the two groups, but significantly lower posttreatment GAD-7 score, and fewer medium to severe posttreatment anxiety patients in the educated group.

Conclusion

Personalized prechemotherapy education involving physician for medical treatment and nursing staff for peri-treatment care, in contrast to traditional brief discussion with physicians during clinic visits and unified informed consent before treatments, may reduce peri-chemotherapy anxiety more efficiently.

Acceptability of telephone support as perceived by patients with cancer: A systematic review

Telephone-based interventions can increase accessibility to healthcare and are increasingly used as a convenient method of providing support. We conducted a systematic review of published literature reporting adult patients' perceptions of the acceptability of, and satisfaction with, telephone-based interventions during or post-treatment for cancer. Systematic searches identified 4,855 articles. Forty-eight articles describing 50 studies were included in the review. Three intervention categories were identified post hoc: (1) telephone follow-up in lieu of routine hospital follow-up, (2) telephone interventions for treatment side-effect monitoring and toxicity management supplementary to usual care, and (3) supplementary psycho-educational telephone interventions. Across studies, some consistent findings emerged. Positive perceptions emphasised the convenience of telephone interventions and increased accessibility to care. Conflicting perceptions of the quality of the support received, the impact of telecare on the patient-healthcare professional relationship and the need for such interventions emerged. In conclusion, the evidence base relating to patients' perceptions of telephone-based interventions is increasing. Interpretation of findings is currently limited by methodological limitations in the primary research. The instruments chosen to assess patient satisfaction quantitatively do not always reflect the patient-centred priorities that emerge from qualitative data. Subsequent research would benefit from well-designed qualitative studies and patient-centred outcome measures to ensure that the individuality of participants' positive and negative experiences is captured.

Issues and Challenges of Instrument Translation

The purpose of this article was to discuss the challenges of instrument translation, using the translation of the Medical Outcomes Study Social Support Survey into Chinese as an example. Brislin’s model of translation, which highlights the need for forward and backward translation, was used. Major considerations in conducting translation, and the strategies used to overcome the challenges arising from cultural and linguistic differences between the source and target languages, were discussed. Examples were used to illustrate how difficulties, such as maintenance of the original intent of the questionnaire, maximization of the cultural relevancy of the concept in question, and enhancement of the comprehensibility of the translated questionnaire, were handled. The importance of literal and cultural adaptation of a developed instrument, rather than its simple word translation in the maintenance of an equivalent translation is highlighted.

A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer

As our society ages, increasing numbers of older Americans will be diagnosed and eventually will die of cancer. To date, psycho-oncology interventions for advanced cancer patients have been more successful in reaching younger adult age groups and generally have not been designed to respond to the unique needs and preferences of older patients. Theories and research on successful aging (Baltes and Baltes 1990; Baltes 1997), health information processing style (Miller 1995; Miller et al 2001) and non-directive client-centered therapy (Rogers 1951, 1967), have guided the development of a coping and communication support (CCS) intervention. Key components of this age-sensitive and tailored intervention are described, including problem domains addressed, intervention strategies used and the role of the CCS practitioner. Age group comparisons in frequency of contact, problems raised and intervention strategies used during the first six weeks of follow up indicate that older patients were similar to middle-aged patients in their level of engagement, problems faced and intervention strategies used. Middle-aged patients were more likely to have problems communicating with family members at intervention start up and practical problems as well in follow up contacts. This is the first intervention study specifically designed to be age sensitive and to examine age differences in engagement from the early treatment phase for late-stage cancer through end of life. This tailored intervention is expected to positively affect patients' quality of care and quality of life over time.

Randomized-Controlled Trial of a Telephone and Mail Intervention for Alcohol Use Disorders: Three-Month Drinking Outcomes

BACKGROUND

Alcohol screening, brief intervention, and referral to specialized treatment (ASBIR) reduce drinking and related harms. Unanswered questions are how to manage nondependent patients with poor response to brief interventions, how to manage dependent patients who do not obtain treatment, and how to ensure population-wide delivery of ASBIR. Telephone-administered counseling may provide answers.

METHODS

We conducted a 12-month randomized controlled trial of a telephone and mail intervention for non-treatment-seeking primary care patients with alcohol use disorders. We enrolled 897 subjects after systematic screening in 18 primary care clinic waiting rooms in and around Madison and Milwaukee, Wisconsin, and subsequent telephone-administered diagnostic interviews. Experimental subjects received up to six sessions of protocol-driven telephone counseling based on principles of motivational interviewing and stages of readiness to change. Control subjects received a pamphlet on healthy lifestyles. The paper reports on 3-month drinking outcomes for men and women with alcohol abuse and dependence.

RESULTS

Male experimental subjects (N=199) manifested a 30.6% decline in risky drinking days, compared with a 8.3% decline in controls (N=201, p<0.001). The total consumption declined by 17.3% compared with 12.9% by controls (p=0.001). Female experimental subjects (N=246) manifested a 17.2% decrease in risky drinking days compared with an 11.5% decrease by controls (N=251; p=NS) and a 13.9% decline in total consumption compared with 11.0% by controls (p=NS). Greater numbers of telephone counseling sessions were associated with greater declines in drinking.

CONCLUSION

Following systematic screening, a six-session telephone and mail intervention is more effective than a pamphlet in reducing drinking at 3 months for non-treatment-seeking men with alcohol abuse and dependence. An intervention effect of the enrollment procedures may have obscured further intervention effectiveness. Telephone counseling shows promise for non-treatment-seeking primary care patients with alcohol use disorders.

Impact of a Peer-Delivered Telephone Intervention for Women Experiencing a Breast Cancer Recurrence

Purpose

A first breast cancer recurrence creates considerable distress, yet few psychosocial interventions directed at this population have been reported. The Southwest Oncology Group conducted a phase III randomized trial to evaluate the effectiveness of a brief telephone intervention.

Patients and Methods

Three hundred five women experiencing a first recurrence of breast cancer were randomly assigned to standard care or intervention. The intervention consisted of four to eight telephone calls delivered over a 1-month period. The calls were conducted by trained peer counselors at a breast cancer advocacy organization, the Y-ME National Breast Cancer Organization, and followed a standard curriculum. Psychosocial distress (Cancer Rehabilitation Evaluation System–Short Form [CARES-SF]) and depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) outcomes were assessed at baseline and 3 and 6 months. The 3-month assessment was the primary end point and is the focus of this article.

Results

Analysis revealed no differences in distress or depressive symptoms at 3 months between the intervention and control groups; at 3 months, 70% of control patients and 66% of intervention patients reported psychosocial distress, and 40% of control patients and 47% of intervention patients exhibited depressive symptoms.

Conclusion

Telephone peer counseling did not lead to better psychosocial outcomes. The persistent distress in these women supports the urgent need for the development and testing of more intensive or different supportive interventions for this group of patients.

Reducing the unmet needs of patients with colorectal cancer: a feasibility study of The Pathfinder Volunteer Program

GOALS OF THE WORK

Many cancer patients experience unmet needs and elevated levels of anxiety and depression. This paper describes a volunteer-delivered intervention to reduce the psychosocial needs of cancer patients and presents findings from a feasibility study of this intervention.

MATERIALS AND METHODS

The telephone-based intervention, called the Pathfinder Program, involves the assignment of volunteers to patients to assist them in addressing their needs as identified in questionnaires. Fifty-two patients with colorectal cancer were involved in the feasibility study, with 18 in the intervention. Sixty-two percent of the sample was male and the mean age was 64 years. Patients' needs were assessed using The Supportive Care Needs Survey, a colorectal cancer symptom checklist, and the Hospital Anxiety and Depression Scale. All patients completed baseline questionnaires (Time 1) and 47 completed Time 2 questionnaires 3 months later.

MAIN RESULTS

The most common needs were fear of the cancer spreading and returning, concerns about the worries of others, gas or wind, changes in weight, and bowel problems such as diarrhea, constipation, and pain. A statistically significant Time 1 to Time 2 decrease in supportive care needs and depression was found for the intervention group.

CONCLUSIONS

The Pathfinder Program has been found to be feasible, acceptable for patients, and has the potential to reduce needs and depression. A larger, randomized controlled trial is needed to determine the impact of this program on colorectal symptoms and anxiety.

Building community-based short-term psychosocial counseling capacity for cancer patients and their families: the Individual Cancer Assistance Network (ICAN) model

Research studies show that 30% of cancer patients experience significant disease-related psychosocial distress, which is often under-recognized and undertreated. To satisfy the need for increased capacity to deliver accessible, affordable, community-based psychosocial counseling for cancer patients and their families, the Bristol-Myers Squibb Foundation developed the Individual Cancer Assistance Network (ICAN) demonstration project. Results of a 3-phase evaluation in diverse community settings in Florida show that ICAN effectively provided "cancer sensitivity"; training for social workers preparing them to deliver short-term individualized psychosocial counseling, on a sliding fee scale, to cancer patients and their families, and to market it effectively to oncologists and the community.

Long-term telephone therapy outcomes for breast cancer patients

We present the results of a breast cancer clinical trial that tested two therapy interventions delivered by telephone. Women (N = 218) with Stages I, II, or III breast cancer were randomly assigned to breast cancer health education or emotional expression interventions, or to a standard care control condition. Outcome and process measures were obtained at baseline, 6-month and 13-month follow-ups. Oncology certified nurses conducted the therapies in six, 30-minute individual phone sessions. Women in the health education condition reported significantly better knowledge and less perceived stress compared to women in the emotional expression and control conditions. No treatment effects, however, were obtained for quality of life or mood, and all women generally improved on these measures over time. Secondary analyses showed that younger women and women with a more advanced stage of breast cancer reported significantly greater avoidant coping. The data show that telephone therapy is a viable delivery modality and that distress improves with time for most women. Overall, this study showed that neither of the two telephone interventions tested had a meaningful effect on quality of life or mood.

Radical prostatectomy: men's experiences and postoperative needs

AIMS AND OBJECTIVES

This study sought to explore men's experiences after radical prostatectomy and whether they perceived their preoperative teaching adequately prepared them for postoperative recovery. Tape-recorded telephone and face-to-face interviews were conducted at days 2, 7 and 21, and 3 and 12 months postdischarge.

BACKGROUND

Although verbal and written instruction about postoperative expectations and care are provided routinely before radical prostatectomy, patients express concern about a lack of preparation in managing urinary incontinence and erectile dysfunction.

DESIGN

This qualitative descriptive study explored in-depth men's experiences during the year following their surgery.

METHODS

Multiple, tape-recorded, semistructured telephone interviews were conducted with 17 participants and a single, in-depth, face-to-face interview was conducted 12 months postoperatively with a subset of five men selected for their reflective and descriptive abilities.

RESULTS

Although participants received comprehensive written and verbal information preoperatively, it was not sufficient to foster their management of all postoperative sequelae. Telephone follow-up, used as a data collection strategy, was helpful in fostering adjustment after surgery and relieved anxiety caused by side effects of surgery and unanswered questions.

CONCLUSIONS

Pre- and postoperative teaching needs to make allowances for the impact of stress on the recall and processing of information. Written information in itself is not adequate to answer necessary questions and provide reassurance. Follow-up telephone support is recommended as a way of fostering adjustment after surgery.

RELEVANCE TO CLINICAL PRACTICE

This study shows that: (i) Written information in itself is not adequate to answer necessary questions and provide reassurance, (ii) Nurses need to be prepared, both educationally and psychologically, to observe non-verbal cues and to address questions and concerns that are rarely voiced in ways that indicate their significance to the person and (iii) Men may not speak about sexuality issues in ways that accurately reflect the extent of their worry and/or distress about erectile dysfunction.

Perceived Helpfulness of Telephone Calls

The purpose of this study was to determine the perceived helpfulness of telephone calls to 83 caregivers of family members with dementia. Study participants were assigned by groups to experimental (n = 41) or attention-only control (n = 42) conditions. Initial baseline interview data and narrative transcripts of telephone calls were used in this study. Major perceived reasons for helpfulness were that participants were assisted in sharing thoughts and feelings, expressing feelings of being overwhelmed, discussing physical and psychosocial problems, forgetting the situation, seeking reassurance, and asking for information; several participants perceived the telephone calls to be lacking in helpfulness. Results from this study suggest family caregivers can be helped through a variety of social support mechanisms.

Efficacy of Therapeutic Group by Telephone for Women With Breast Cancer

A pilot study was conducted to test the efficacy of a therapeutic group by telephone conference call for women with breast cancer. Sixty-six women with stage I or stage II breast cancer consented to participate in the study. Participants were randomly assigned to a usual psychosocial care or intervention group, using a permuted block method. Only 2 of 68 patients dropped out of the study, which included 27% African Americans. Assessments at 3 time periods (pretest, immediately after the intervention, and 3 months after the group ended) included evaluation of quality of life (QOL), mood, and immune function. ttests were performed to determine if differences on important variables existed at pretest. The intervention group had worse QOL and mood scores than did the control group on the pretests. A mixed-model repeated-measures procedure controlling for pretest differences was used to analyze data. A significant Group by Time interaction was found for spiritual well-being and mood. These differences were not in the expected direction. The intervention group showed improvement in QOL and mood during the intervention, but showed decompensation following the intervention. Conversely, the control group demonstrated stable or declining scores. This intervention is feasible and practical for women with breast cancer, especially African American participants. The puzzling results suggest several areas for future research, including a better conceptual fit with outcome measures, increasing dosage, and exploration of the value of emotional expression.

Cognitive-behavioral intervention for distress in patients with melanoma: comparison with standard medical care and impact on quality of life

BACKGROUND

Melanoma accounts for > 79% of skin cancer-related deaths, although it accounts for only 4% of skin cancer incidence. Given the potential for lethality, it is likely that patients with melanoma may experience significant emotional distress. The current study was designed to determine the effect of a cognitive-behavioral intervention on distress and health-related quality of life (HRQOL) in patients with melanoma who had medium-to-high distress.

METHODS

Forty-eight patients who had Global Severity Index scores >or= 60 2 months after their initial visit to the multidisciplinary melanoma clinic were randomized to receive either standard care or 4 sessions of a cognitive-behavioral intervention (CBI). Repeated assessments using the Brief Symptom Inventory, the Medical Outcomes Survey Short Form-36, and the State-Trait Anxiety Inventory occurred at baseline, at 2 months, and at 6 months after intervention for both groups.

RESULTS

An intent-to-treat analysis did not reveal significantly lower distress in the CBI group at 2 months or 6 months of follow-up, although differences were noted in anxiety and HRQOL. An effect-of-intervention analysis did reveal lower levels of distress in the CBI group at 2 months, with differences approaching significance at 6 months.

CONCLUSIONS

The four-session CBI significantly reduced distress and improved HRQOL for a period of 2 months in patients with melanoma who had medium-to-high distress, with improved general health evident 6 months after the intervention. Some variation in results was revealed in an intent-to-treat analysis. The initial evidence from the current study showed that a brief intervention may be effective for creating change in individuals with cancer who have increased distress, although further research is needed to identify the most optimal approach for delivering the intervention.

Short-term effects of telephone therapy for breast cancer patients

The authors report the short-term effects of a clinical trial testing 2 telephone therapies for breast cancer patients. Women (N = 222) with breast cancer were recruited and randomly assigned to cancer education, emotional expression, or standard care. Oncology nurses conducted 6 individual 30-min-therapy phone sessions. Women in the cancer education condition reported greater perceived control than women in the standard care condition. No treatment effects were obtained for mood or quality of life. These are the 1st data from a large-scale study testing telephone therapy, and they suggest that such therapies may be ineffective. Explanations for the results include therapy type and delivery, participant characteristics, short- versus long-term results, therapy conent, and whether therapy is necessary for breast cancer patients.

Separating the apples and oranges in the fruit cocktail: the mixed results of psychosocial interventions on cancer survival

In past reviews of the literature on psychosocial interventions for cancer patients, different reviewers have reached disparate conclusions about the ability of a psychosocial intervention to have an impact on cancer survival. This article highlights some of the basis for differences of opinion, including the range of psychosocial interventions provided to patients and the challenges inherent in conducting research studies of this type. Social workers who work with cancer patients at vulnerable times need to understand what the current evidence shows can be gained from participation in a psychosocial intervention. Several key questions have been identified that can provide the basis for future rigorous studies. The role of the social worker in participating and shaping research on the relationship of psychosocial intervention and cancer survival is also discussed.

Quality of life in breast cancer patients--not enough attention for long-term survivors?

In a study of breast cancer survivors, the authors used the European Organization for Research and Treatment of Cancer core questionnaire + breast module (EORTC QLQ-C30/+BR23) and the Functional Assessment of Cancer Therapy-Breast (FACT-B)for the assessment of quality of life (QoL). The main focus of this study was to look at the effect of time elapsed since initial treatment on the patients' QoL. Eighty-seven female patients (average age of 53.9 +/- 8.7 years) were included in the study. All women had received curative cancer therapy. The average time elapsed since start of initial treatment was 4.7 +/- 4.3 years. Reduced QoL, especially in the areas of emotional, social, and sexual functioning, was found not only after initial treatment (1-2 years) but also after long posttreatment survival (> 5 years). From these findings, needs for specific psycho-oncological interventions are derived. The findings imply that besides recovering from the acute consequences of cancer therapy, long-term survivors of breast cancer (> 5 years after initial treatment) still may have a special need for psycho-oncological support.

A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners

A single-arm pilot study explored the feasibility of adapting in Interpersonal Psychotherapy (IPT) by telephone to reduce psychological distress and to enhance coping during cancer treatment. Therapy focuses on role transitions, interpersonal conflicts, and grief precipitated by cancer. Breast cancer patients receiving high-dose chemotherapy received weekly sessions with a psychologist throughout chemotherapy and for 1 month afterwards. Patients could invite one 'partner' to receive individual telephone IPT. Psychosocial functioning was assessed using standardized measures at study entry, after chemotherapy, and following telephone IPT. Accrual and participation supplied evidence of feasibility: 14 patients and 10 partners were recruited, 82.5% of those eligible. Patients had a mean of 16 sessions; partners had a mean of 11. Participants rated their satisfaction with the program between 'good' and 'excellent'. A test of the efficacy of telephone IPT requires a larger, randomized trial. In order to standardize the intervention, a treatment manual was developed. This study indicated the importance of outreach to family members as well as to cancer patients, intensive patient education about oncology treatment and the medical care setting, and psychosocial services that continue after cancer treatment has been completed.

The early post-operative concerns of men after radical prostatectomy

The aim of this study was to explore the concerns of men with urinary incontinence in the early weeks of recovery after radical prostatectomy for early stage prostate cancer. As part of a larger study evaluating effectiveness of intensive physiotherapy for post prostatectomy incontinence, semistructured interviews were conducted at study entry. Sixty-three men approximately 8 weeks post-surgery participated. The descriptive data were analysed for themes. Pre-operative concerns focused on dealing with the diagnosis of prostate cancer, information gathering and decision-making. Post-operatively, a frequently repeated concern was lack of knowledge about the post-surgery recovery period. Specifically, men stated they did not process much of the detailed pre-operative teaching provided by the urologists and the nurses because of the overwhelming nature of the diagnosis. As a result, at discharge, they revealed many knowledge gaps about catheter care, post-operative pain, incontinence and erectile dysfunction. Participants also perceived a lack of health care professional support. These information deficits severely affected quality of life and healthy post-operative rehabilitation. The results of the informal interviews provide a deeper understanding of the post-operative recovery experience and suggest some strategies for improving the early weeks of recovery after radical prostatectomy including telephone follow-up, additional written information and on-going support.

Promoting cancer screening among the first-degree relatives of breast and colorectal cancer patients: the design of two randomized trials

BACKGROUND

In this paper two large nationwide trials are described, both of which will test a comparable telephone-based counseling intervention to promote cancer screening among the first-degree relatives (FDRs) of breast and colorectal cancer patients. The unit of randomization will be the family unit of eligible FDRs. Access to FDRs will be obtained from their relatives with cancer. Selected intervention and design issues are reviewed, including how both projects will respond to FDRs who exhibit significant levels of cancer-specific anxiety or distress and how potential high-risk cancer families will be accommodated.

METHODS

Pursuant to the development of both studies, two feasibility surveys were conducted to determine whether patients would grant access to their FDRs and whether the FDRS identified by these patients would be receptive to the telephone intervention.

RESULTS

Approximately 80% (106 of 132) of breast cancer patients agreed to provide access to their eligible FDRs when contacted on-site at participating hospitals and clinics. Of those subsequently selected for telephone follow-up (n = 95 or 90%), 80% (n = 76) were successfully contacted by telephone, and of these 97% (n = 74) provided the names and telephone numbers of their FDRs. Among colorectal cancer patients contacted on-site (n = 46), 96% (n = 44) agreed to provide access to their FDRs, and of those contacted by telephone (n = 33 or 75%), 91% (n = 30) provided the requested information about their FDRs. Once contacted, 95% of breast cancer FDRs (55 of 58) and 91% of colorectal cancer patients (51 of 56) endorsed the intervention strategy.

CONCLUSIONS

It is argued that this intervention, if proven effective, could provide an exportable strategy for reaching large numbers of high-risk individuals to promote cancer screening.

Assessment and treatment of depression in the cancer patient

The prevalence, diagnosis, and treatment of depression in the cancer patient are reviewed. Although frequently encountered in the cancer patient population, depression often remains undiagnosed and untreated. This carries grave consequences in that depressed cancer patients experience a poorer quality of life, are less compliant with medical care, have longer hospital stays, and have higher mortality rates. Diagnostic assessment of depression in the cancer patient raises difficulties both upon phenomenological and etiological grounds. In particular, the presence of neurovegetative symptoms which may be secondary to either cancer or depression may cloud the diagnostic picture. Due to the serious consequences of unrecognized depression, a more sensitive inclusive approach to diagnosis is recommended in the clinical setting. Finally, the limited data regarding treatment of depression in patients with cancer is reviewed. This includes a discussion of both psychosocial and pharmacological interventions which are shown to alleviate depression, improve quality of life measures, improve immune function, and lengthen survival time.