Stepped-care to improve mental health outcomes among underserved patients with lung and head and neck cancer.

Abstract

The comparative effectiveness study (ClinicalTrials.gov, NCT03016403) assessed the effects of a stepped-care intervention versus usual care on mental health outcomes, including anxiety, depression, coping self-efficacy, emotional distress (anxiety and depression combined), health-related quality of life (HRQoL), and perceived stress among underserved patients (i.e., low-income, uninsured, underinsured) with lung cancer (LC) and head-and-neck cancer (HNC). In a randomized controlled trial, we investigated if 147 patients who received the stepped-care intervention had better mental health outcomes compared to 139 patients who received usual care. Using an intent-to-treat approach, we analyzed outcomes with linear mixed models. For the primary outcomes estimated mean differences (denoted by "Δ"), depression (Δ=1.75, 95% CI=0.52, 2.98, p=0.01) and coping self-efficacy (Δ=-15.24, 95% CI=-26.12, -4.36, p=0.01) were better for patients who received the intervention compared to patients who received usual care, but anxiety outcomes were not different. For secondary outcomes, emotional distress (Δ=1.97, 95% CI: 0.68, 3.54, p =< 0.01) and HRQoL (Δ=-4.16 95% CI: -7.45, -0.87, p=0.01) were better for patients who received the intervention compared to usual care patients, while perceived stress was not different across groups. The stepped-care intervention influenced depression and coping self-efficacy, important outcomes for patients with acute illnesses like LC and HNC. Although differences in emotional distress met the minimally important differences (MID) previously reported, depression and HRQoL were not above the MID threshold. Our study is among a few to report differences in mental health outcomes for underserved LC and HNC patients after receiving a psychological intervention. NCT03016403.