Telemedicine effective treating pain, depression in patients with cancer

Patients with cancer who participated in a program that included telephone-based care management and home-based automated symptom monitoring had greater improvement in pain and depression compared with patients who received usual care, according to a study published in the July 14 issue of the Journal of the American Medical Association.

Kurt Kroenke, MD, and colleagues conducted the Indiana Cancer Pain and Depression (INCPAD) trial in 16 community-based urban and rural geographically dispersed oncology practices. Participating patients had depression, cancer-related pain, or both, and were randomly assigned to receive the intervention or usual care. The researchers were based at the Richard Roudebush VA Medical Center, Indiana University, and Regenstrief Institute, Indianapolis.

Patients in the intervention group received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or Internet. A nurse care manager trained in assessing symptom response and medication adherence, providing pain and depression-specific education, and adjusting treatment according to evidence-based guidelines managed telephonic care.

Of the 405 participants enrolled in the study, 131 had depression only, 96 had pain only, and 178 had depression and pain. Of the 274 patients with pain, 137 patients in the intervention group had greater improvements in pain severity as assessed by the Brief Pain Inventory (BPI; 30 percent or greater decrease in BPI) over the 12 months of the trial than the 137 patients in the usual-care group. Of the 309 patients with depression, the 154 patients in the intervention group had significantly greater improvement in depression severity as assessed by the Hopkins Symptom Checklist (HSCL; 50 percent or greater decrease in HSCL) than the 155 patients in the usual-care group.

Between-group differences in secondary outcomes that were not pain- or depression-specific also were assessed, and the intervention group had better outcomes for several health-related quality-of-life domains, including mental health, vitality, anxiety, and physical symptom burden.

"Our INCPAD trial has several important findings. First, the telecare management intervention resulted in significant improvements in both pain and depression. Second…that it is feasible to provide telephone-based, centralized symptom management across multiple, geographically dispersed, community-based practices in both urban and rural areas by coupling human with technology-augmented patient interactions," the authors write. "Third, the findings did not appear to be confounded by differential rates of co-interventions or healthcare use."