The purpose of this study is to determine whether a brief psychosocial intervention together with early palliative care are feasible, acceptable and effective in the reduction of depressive symptoms of patients with advanced cancers starting first line palliative chemotherapy.
Patients with advanced cancer report physical, emotional, social and existential problems that may be due to the cancer itself or its treatment. Previous studies have demonstrated the benefit of early inclusion of palliative care (PC) in combination with standard oncologic care in reducing depressive symptoms, improving quality of life, increasing survival and also decreasing unnecessary invasive procedures. However, patients continue to arrive late at PC, even in large comprehensive cancer centers. One of the barriers is the stigma of PC perceived by patients and health professionals as "a place to die." The primaries objectives are to evaluate the feasibility and satisfaction of patients with advanced cancer submitted to a brief psychosocial intervention based on Cognitive Behavioral Therapy (CBT) in addition to early PC and to evaluate the impact of these interventions on the reduction of depressive symptoms. A randomized, open-label, phase II trial, with two intervention arms and a control group. It will be included 150 patients with advanced cancer initiating palliative chemotherapy who meet the selection criteria. Participants will be recruited from the outpatient oncology clinics from the Barretos Cancer Hospital and will be randomized in one of the three treatment arms: arm A, five weekly sessions of brief psychosocial interventions based on CBT in combination with early PC; arm B, early PC only; arm C, standard oncologic care. The Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), Brazilian version of the Edmonton Symptom Assessment System (ESAS-br), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 PAL (EORTC QLQ-C15-Pal), 13-item measure of patient satisfaction (FAMCARE-P13), and the Disease Understanding Protocol, will be the instruments used for data collection. Patients will answer these instruments at baseline and after 45, 90, 120, and 180 days after randomization. An interim analysis is planned to occur after the inclusion of 20 participants with complete data in each arm; if the Cohen's effect size between the arms A and B is small (d\<\<0.2), the study will continue only with arms B and C.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
63
Five weekly sessions of a Brief Psychosocial Intervention based of Behavioral Cognitive Therapy designed specifically for the present study.
Early integration of Palliative Care into the standard oncologic care. Patients starting first line chemotherapy will receive immediately evaluation by the board-certified palliative care physicians.
Barretos Cancer Hospital
Barretos, São Paulo, Brazil
Change from baseline in depression symptoms on the HADS-D and PHQ-9 at day 90.
Time frame: Baseline, Day 90.
Change from baseline in satisfaction with care on the FAMCARE-patient scale at days Days 45, 90, 120 and 180.
Evaluation of the satisfaction perceived by the patients regarding health care.
Time frame: Baseline, Days 45, 90, 120 and 180.
Descriptive results about feasibility of the study.
Time frame: Average duration in minutes of each intervention session (both regarding Palliative Care consultation and Psychological session); number of non-attendance to the interventions (absences); reasons reported by patients for missing.
Change from baseline in depressive symptoms on the HADS-D and PHQ-9 at days 45,120 and 180.
Time frame: Baseline, Days 45, 120, 180.
Change from baseline in anxiety symptoms on the HADS-A at days 45,90, 120 and 180.
Time frame: Baseline, Days 45, 90, 120, 180.
Proportion of patients answering that their cancer is curable as measured using an adapted instrument to evaluate Cancer Understanding.
Considering that all patients included will have incurable advanced cancers, those answering that their disease is curable will be interpreted as not adequately aware of their prognosis.
Time frame: At 90, 120 and 180 days.
Change from baseline in cancer symptoms on the ESAS at days 45,90, 120 and 180.
Time frame: Baseline, Days 45, 90, 120, 180.
Change from baseline in quality of life on the EORTC QLQ-C15-Pal at days 45,90, 120 and 180.
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Time frame: Baseline, Days 45, 90, 120, 180.