A Stepped Care Intervention to Reduce Disparities in Mental Health Services Among Cancer Patients and Caregivers

University of Colorado Denver (CU Denver)

Status: Completed

Conditions: Cancer, Lung; Cancer, Head and Neck

Treatments: Behavioral: Stepped-Care Intervention; Behavioral: Enhanced Usual Care

Study type: Interventional

Funder types: Other

Identifiers

NCT03016403

16-2621.cc

AD-1511-33395 (Other Grant/Funding Number)

Details and patient eligibility

About

Medically under-served (i.e., low-income, uninsured, underinsured) cancer patients generally encounter significant disparities in accessing care for their mental health needs while undergoing toxic treatments that provide considerable physical and emotional stress. Thus, the investigators propose to adapt evidence-based strategies to a stepped-care intervention model to address the mental health needs of under-served lung cancer (LC) and head and neck cancer (HNC) patients and their caregivers across several levels of symptom severity (e.g., mild, moderate, or severe symptoms of depression and anxiety).

Enrollment: 535 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

1. LC and HNC patients:

   Inclusion Criteria:

   • Newly diagnosed LC and/or HNC (within a month of recruitment date from the date of 1st visit oncology, Ear Nose and Throat (ENT), or radiation clinic visit/consultation upon pathologic tissue diagnosis;

   • LC and/or HNC patients at any stage of diagnosis (Stages 0-IV);

   • Over 18 years old;

   • English and/or Spanish speaking;

   • Medically underserved, as defined by at least one or several of the following:

     1. Low-income: Below 400% of the 2016 Federal poverty levels;
     2. Uninsured: No health insurance (public or private insurance);
     3. Underinsured: e.g.: Public insurance (Medicaid, Medicare exclusive, VA); and/or 10% of annual income on out-of-pocket medical expenses for individuals below 200% of the 2016 Federal poverty levels.

   Exclusion Criteria:

   • Individuals who do not meet eligibility criteria, including individuals who do not speak English or Spanish;
   • Those who refuse treatment at one of three hospital sites;
   • Decisionally-challenged adults with cognitive or personality impairment;
   • Suicidal ideation, or
   • Intoxication (alcohol or drugs) that might interfere with their ability to consent or participate in the study;
   • Individuals from vulnerable populations (e.g., inmates or individuals on probation,
   • homeless,
   • pregnant women, and
   • those with auditory impairment.

   Note: Individuals who become pregnant or develop auditory impairments after they have been randomized to study condition may remain in the study until completion.

2. Caregivers of LC and/or HNC patients

Inclusion Criteria:

• Primary caregiver of a newly diagnosed LC and/or HNC patient (per criteria for patients);

• Over 18 years old;

• English and/or Spanish speaking;

• Medically underserved, as defined by at least one or several of the following:

  1. Low-income: Below 400% of the 2016 Federal poverty levels;
  2. Uninsured: No health insurance (public or private insurance);
  3. Underinsured:

• (c.1) Public insurance (i.e., Medicaid, Medicare exclusive, VA);

• (c.2) 10% of annual income spent on out-of-pocket medical expenses for individuals below 200% of the 2016 Federal poverty level.

Exclusion criteria:

• Individuals who do not meet eligibility criteria, including individuals who do not speak English or Spanish [at the discretion of the Site Coordinators upon recruitment];

• Caregivers of patients who refuse treatment at one of three hospital sites.

• Decisionally challenged adults with:

  1. cognitive or personality impairment,
  2. suicidal ideation, or
  3. intoxication (alcohol or drugs) that might interfere with their ability to consent or participate in the study [at the discretion of the Site Coordinators upon recruitment or the Counselor during the intervention];

• Individuals from:

  1. vulnerable populations (e.g., inmates or individuals on probation, homeless,
  2. pregnant women, and
  3. those with auditory impairment [at the discretion of the Site Coordinators upon recruitment]).
  4. Individuals who become pregnant or develop auditory impairments after they have been randomized to study condition may remain in the study until completion.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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535 participants in 2 patient groups

Stepped-Care Intervention

Experimental group

Description:

Intervention strategies are grounded in evidence-based Cognitive Behavioral Therapy (CBT), that includes stress management and relaxation treatment strategies and coping skills training. Treatment strategies have been adapted from the Transactional Model of Stress and Coping (TMSC), a theoretical model that predicts that individuals who are able to cope and adapt to the stress related to cancer treatment or caregiving will report less psychological distress than those unable to cope.

Treatment:

Behavioral: Stepped-Care Intervention

Enhanced Usual Care

Active Comparator group

Description:

Denver Health, St. Mary's and St. Joseph's hospitals provide supportive mental health care for patients such as printed materials, support groups, crisis counseling, and specialized care (e.g., psychiatric medication). Because the amount of usual mental health care that each patient receives varies at each site, the investigators will standardize and monitor the usual care arm across the three sites with an enhanced usual care condition.

Treatment:

Behavioral: Enhanced Usual Care