Thanks to a new four-year $2.5 million National Cancer Institute grant, the University of Arizona College of Nursing is investigating a precision approach to decrease psychological distress in cancer patients and their family caregivers during treatment.
The project seeks to see if two interventions that already have proven successful in previous research can be employed in a Sequential Multiple Assignment Randomized Trial, or SMART. While more traditional approaches employ a "one-size-fits-all" approach to treatment, SMART takes a more individualized approach to assessing the care needs of cancer patients.
"The whole idea of a randomized clinical trial is that you give an intervention to everybody in the same way, whereas SMART designs are predicated upon the idea that you need to reassess at different time points, and possibly change to a different intervention along the way," said Professor Terry A. Badger, PhD, the study's principal investigator.
Using SMART, Dr. Badger and her team will employ two post-treatment innovations in the study, which is called "Improving Informal Caregivers' and Cancer Survivors' Psychological Distress, Symptom Management and Health Care Use." The first is a printed Symptom Management and Survivorship Handbook featuring evidence-based, self-care strategies for symptoms. The second is a telephone counseling intervention used in tandem with the handbook to manage elevated depression and anxiety, which are particularly burdensome during cancer treatment.
"We're using a precision approach to determine which of the interventions is the right one for the right patient and in the right sequence," Dr. Badger said. The result could be a more flexible approach to improve physical, psychological and social well-being during treatment.
“My goal from the beginning has been to develop interventions that improve the lives, both mentally and physically, of all those impacted by this disease." ~ Dr. Terry Badger
Statistics from the American Cancer Society show that 30 percent of cancer patients suffer serious psychological distress or depression, and that 30 to 40 percent of their caregivers suffer the same negative consequences. Traditional clinical trials that involve cancer support groups and mental health visits to advance psychosocial care can be effective, but research shows that only 25 percent of patients use support groups, and that 47 percent of patients who schedule a mental health visit typically fail to show up.
"There is nothing wrong with face-to-face interventions," Dr. Badger said. "But obstacles such as child care, transportation, costs and stigma often create an undue burden that prevents patients from receiving the care they need. My goal from the beginning has been to develop interventions that can be delivered easily and remove all sorts of access barriers so that patients and their families can get supportive care."
During the course of the four-year study, nearly 600 cancer patients and their family caregivers will participate in a 12-week program. Survivors and caregivers enrolled in the study will receive one of the interventions. Progress will be monitored, with a reassessment at the four-week mark. Depending on the symptom assessment, they either will stay in the first intervention they were assigned to for eight more weeks or be reassigned to the second intervention.
"We need to make sure that as we battle cancer that we also are doing all that we can for the well-being of the patient and the caregivers," said UA President Robert C. Robbins, MD. "Dr. Badger's work goes the extra mile to look for interventions that improve the lives, both mentally and physically, of all those impacted by this disease. Her work furthers our ability to see patient care holistically, and I am pleased to see this new support for her efforts."
"It's all about trying to figure out what the right treatment for that particular survivor/caregiver dyad is," Dr. Badger said. "At the end of the study, we will be able to critically look and see, 'For a person with these characteristics, treatment A might be a better first step, and then treatment B. Whereas for a different person, it might be better to do treatment B first and then treatment A.'"
The end result, Dr. Badger hopes, will be to disseminate the study's results to change cancer care, ensuring that cancer patients and their caregivers have their symptom management and psychosocial needs met. In the long run, the impact of the interventions could be huge.
"A majority of patients prefer the flexibility of these kinds of interventions," she said. "We can work with them around their work schedule, their life schedule, to ensure they get the treatment they deserve without causing them more stress. The bottom line is that this is all about improving the care for survivors and caregivers."
The study was preceded by interdisciplinary work involving the SHINE – Symptoms, Health, INovation and Equity – group of researchers, co-founded by Dr. Badger and Chris Segrin, PhD, professor in the UA Department of Communication.
"This research is an outgrowth of a nearly 20-year collaboration among the UA colleges of Nursing and Social and Behavioral Sciences," Dr. Segrin said. "This research always has been aimed at developing and delivering interventions for cancer survivors and their caregivers that address the emotional and social aspects of their well-being in addition to physical symptoms. These current projects will advance the precision delivery of these interventions."
The members of the SHINE Research for Cancer Survivors and Caregivers group are: Tad Pace (UA College of Nursing), Maria Figueroa (UA College of Nursing), Tracy Crane (UA College of Nursing), Terry Badger (UA College of Nursing), Alla Sikorskii (Michigan State Department of Psychiatry), Molly Hadeed (UA College of Nursing), Bettina Hofacre (UA College of Nursing), and Chris Segrin (UA Department of Communication).