Trial Information

Effectiveness Study of a Stepped Care Depression Algorithm for Patients With Cancer

This controlled trial has tested the effectiveness of a socio-culturally tailored depression
care program that includes a patient-centered approach to antidepressant medication
management or structured psychotherapy (Problem Solving Treatment (PST)), patient/family
depression education, treatment maintenance and relapse prevention counseling. Intervention
enhancements include: depression care management based on a stepped care depression
treatment algorithm; extension of the oncology care management team with a master's degreed
social worker, who acts as Cancer Depression Clinical Specialist (CDCS) and provides PST,
treatment follow-up and feedback to the oncologist, and who facilitates patient-provider
communication and health system and community resources navigation; a psychiatric
consultant, who provides supervision of the CDCS and consultation and antidepressant
medication prescription for individual patients; and a didactic for oncologists on
depression management. Cultural sensitivity and competency enhancements include: patient
choice of first line treatment (antidepressant medication/PST) and degree of family
participation in their depression care; PST tailored for language and literacy of patients
with cancer; bilingual, bicultural CDCS; Spanish educational materials; and communication
facilitation. Enhanced Usual Care (EUC) patients will receive the care and services
routinely provided patients with cancer plus an educational/resource pamphlet for patients
and for family members(on depression and cancer, depression treatment, talking with your
doctor about your depression, and medical center and community mental health care
resources). With patient consent, the oncologist is informed if EUC patients screen positive
for major depression/dysthymia.