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Improving Primary Care for Older Adults with Cancer and Depression

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Abstract

Background

Depression is common among older cancer patients, but little is known about the optimal approach to caring for this population. This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program, a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis.

Methods

Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study. Subjects were 60 years or older with major depression (18%), dysthymic disorder (33%), or both (49%), recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states. Patients were randomly assigned to the IMPACT intervention (n = 112) or usual care (n = 103). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education, care management, support of antidepressant management, and brief, structured psychosocial interventions including behavioral activation and problem-solving treatment.

Results

At 6 and 12 months, 55% and 39% of intervention patients had a 50% or greater reduction in depressive symptoms (SCL-20) from baseline compared to 34% and 20% of usual care participants (P = 0.003 and P = 0.029). Intervention patients also experienced greater remission rates (P = 0.031), more depression-free days (P < 0.001), less functional impairment (P = 0.011), and greater quality of life (P = 0.039) at 12 months than usual care participants.

Conclusions

The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care settings.

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Correspondence to Jesse R. Fann MD, MPH.

Additional information

Supported by grants from the John A. Hartford Foundation, the California Healthcare Foundation, the Hogg Foundation, and the Robert Wood Johnson Foundation.

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Fann, J.R., Fan, MY. & Unützer, J. Improving Primary Care for Older Adults with Cancer and Depression. J GEN INTERN MED 24 (Suppl 2), 417–424 (2009). https://doi.org/10.1007/s11606-009-0999-4

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