Benefits of phone outreach in cancer patients may be replicated across other conditions

Easing the two most common physical and psychological symptoms in cancer patients--pain and depression--may be as simple as a phone call, according to a new study examining the use of telemedicine in cancer patients published in the July 14 issue of the Journal of the American Medical Association.

The study, called the Indiana Cancer Pain and Depression (INCPAD) trial, included patients in 16 community-based urban and rural cancer practices, with 202 patients assigned to the intervention program and 203 receiving usual care.

In the 'telecare' or intervention group, a primary-care physician and nurse team worked with oncology patients who regularly reported symptoms by interactive telephone voice recording or over the Internet. Patients also received direct phone calls from the nurse, who provided symptom education, encouraged treatment adherence and assessed symptom response to medication. The team then reported a patient's status to the oncologist, who ultimately decided about matters such as increasing or decreasing medication doses.

'Usual care' consisted of screening for pain and depression by an oncologist and subsequent treatment.

Of the 405 patients, 131 had depression only, 96 had pain only, and 178 had both depression and pain. After 12 months, every intervention-group patient had significantly greater improvement with his or her respective symptoms than those in the usual-care group.

"Using this approach did not add to oncologists' clinical burden," said lead author Kurt Kroenke, MD, from the Indiana University School of Medicine and Regenstrief Institute in Indianapolis. However, "Our reimbursement system needs to change to accommodate these approaches," he said. "If the reimbursement comes in, it could be economical."

And that may become a reality, as insurers begin to catch on to the potential cost savings. Jesse Fann, MD, MPH, from the Department of Psychiatry and Behavioral Sciences at the University of Washington in Seattle, told Medscape Medical News that, for depression, telemedicine has cost advantages. "There is emerging evidence that cost-efficient approaches, like the one described in this article, will play an important role in decreasing the cost of delivering effective mental health treatment."

Encouragingly, the success of the collaborative care approach in easing cancer pain and depression could potentially be replicated across several conditions, both physical and psychological, the researchers concluded.

To learn more:
- read the article in Medscape Medical News
- see this HealthDay piece via Bloomberg Businessweek
- here's the abstract in the Journal of the American Medical Association

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