Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T07:13:36.547Z Has data issue: false hasContentIssue false
  • English
  • Français

Managing Anxiety from Cancer (MAC): A pilot randomized controlled trial of an anxiety intervention for older adults with cancer and their caregivers

Published online by Cambridge University Press:  05 April 2021

Kelly M. Trevino Open the ORCID record for Kelly M. Trevino [Opens in a new window] ,
Amy Stern ,
Robin Hershkowitz ,
Soo Young Kim ,
Yuelin Li ,
Mark Lachs  and
Holly G. Prigerson
Kelly M. Trevino*
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY
Amy Stern
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY Weill Cornell Medicine,New York, NY
Robin Hershkowitz
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY New York Medical College, Valhalla, NY
Soo Young Kim
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY
Yuelin Li
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY
Mark Lachs
Affiliation:
Weill Cornell Medicine,New York, NY NewYork-Presbyterian Hospital, New York, NY
Holly G. Prigerson
Affiliation:
Weill Cornell Medicine,New York, NY NewYork-Presbyterian Hospital, New York, NY
*
Author for correspondence: Kelly M. Trevino, 641 Lexington Ave., 7th Floor, New York, NY 10065, USA. E-mail: trevinok@mskcc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Anxiety is common in older adults with cancer (OACs) and their caregivers and is associated with poor outcomes including worse physical symptoms, poor treatment adherence and response, and longer hospitalizations. This study examined the feasibility, acceptability, adherence, and preliminary efficacy of a cognitive-behavioral therapy (CBT) intervention for OACs and their caregivers.

Method

Patients with active cancer age 65 years and older and their caregivers were randomized to Managing Anxiety from Cancer (MAC), a seven-session CBT-based psychotherapy intervention delivered over the telephone or usual care. Patients and caregivers completed the intervention separately with licensed social workers. Self-report measures of anxiety, depression, and quality of life were administered after randomization and following intervention completion. Analyses were conducted separately for patients and caregivers and at the dyad level. Hierarchical Linear Modeling accounted for the within-dyad intraclass correlation coefficients (ICCs) by random intercepts associated with the dyads.

Results

Twenty-nine dyads were randomized; 28 (96.6%) patients and 26 (89.7%) caregivers completed all study procedures. Of dyads randomized to MAC, 85.7% (n = 12) of patients and caregivers completed all seven sessions. Most patients (≥50%) and over 80% of caregivers rated the overall intervention and intervention components as “moderately” to “very” helpful. MAC was associated with a greater reduction in anxiety among dyads than usual care, the effect of MAC was greater in caregivers than in patients, and improvement in patient anxiety was associated with the reduction in caregiver anxiety. However, these results did not reach statistical significance.

Significance of results

This pilot study demonstrates the feasibility of MAC and suggests strategies for improving acceptability, with a focus on adherence. Furthermore, these results indicate that MAC is promising for the reduction of anxiety in OAC–caregiver dyads and may be particularly beneficial for OAC caregivers. Larger randomized controlled trials are needed to evaluate the efficacy of MAC.

Keywords

AnxietyCancerCaregiverCognitive-behavioral therapyOlder adult
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 2 , April 2021 , pp. 135 - 145
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association, DSM-5 Task Force (2013) Diagnostic and statistical manual of mental disorders: DSM-5™, 5th ed. American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596Google Scholar
Andersen, BL, DeRubeis, RJ, Berman, BS, et al. (2014) Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: An American Society of Clinical Oncology guideline adaptation. Journal of Clinical Oncology 32(15), 1605–1619. doi:10.1200/jco.2013.52.4611CrossRefGoogle Scholar
Atkins, DC (2005) Using multilevel models to analyze couple and family treatment data: Basic and advanced issues. Journal of Family Psychology 19(1), 98–110. doi:10.1037/0893-3200.19.1.98CrossRefGoogle ScholarPubMed
Ayers, CR, Sorrell, JT, Thorp, SR, et al. (2007) Evidence-based psychological treatments for late-life anxiety. Psychology and Aging 22(1), 8–17. doi:10.1037/0882-7974.22.1.8CrossRefGoogle ScholarPubMed
Badgwell, B, Stanley, J, Chang, GJ, et al. (2013) Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery. Journal of Surgical Oncology 108(3), 182–186. doi:10.1002/jso.23369CrossRefGoogle ScholarPubMed
Bambauer, KZ, Zhang, B, Maciejewski, PK, et al. (2006) Mutuality and specificity of mental disorders in advanced cancer patients and caregivers. Social Psychiatry and Psychiatric Epidemiology 41(10), 819–824. doi:10.1007/s00127-006-0103-xCrossRefGoogle ScholarPubMed
Bluethmann, SM, Mariotto, AB and Rowland, JH (2016) Anticipating the “silver tsunami”: Prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiology, Biomarkers & Prevention 25(7), 1029–1036. doi:10.1158/1055-9965.epi-16-0133CrossRefGoogle ScholarPubMed
Brenes, GA, Danhauer, SC, Lyles, MF, et al. (2015) Telephone-delivered cognitive behavioral therapy and telephone-delivered nondirective supportive therapy for rural older adults with generalized anxiety disorder: A randomized clinical trial. JAMA Psychiatry 72(10), 1012–1020. doi:10.1001/jamapsychiatry.2015.1154CrossRefGoogle ScholarPubMed
Brown, LF and Kroenke, K (2009) Cancer-related fatigue and its associations with depression and anxiety: A systematic review. Psychosomatics 50(5), 440–447. doi:10.1176/appi.psy.50.5.440CrossRefGoogle ScholarPubMed
Bruera, E, Schmitz, B, Pither, J, et al. (2000) The frequency and correlates of dyspnea in patients with advanced cancer. Journal of Pain and Symptom Management 19(5), 357–362.CrossRefGoogle ScholarPubMed
Carroll, KM and Nuro, KF (2002) One size cannot fit all: A stage model for psychotherapy manual development. Clinical Psychology: Science and Practice 9(4), 396–406.Google Scholar
Cella, DF, Tulsky, DS, Gray, G, et al. (1993) The functional assessment of cancer therapy scale: Development and validation of the general measure. Journal of Clinical Oncology 11(3), 570–579.CrossRefGoogle ScholarPubMed
Cella, D, Hahn, EA and Dineen, K (2002) Meaningful change in cancer-specific quality of life scores: Differences between improvement and worsening. Quality of Life Research 11(3), 207–221.CrossRefGoogle ScholarPubMed
Chan, CM, Wan Ahmad, WA, Yusof, MM, et al. (2015) Effects of depression and anxiety on mortality in a mixed cancer group: A longitudinal approach using standardised diagnostic interviews. Psycho-Oncology 24(6), 718–725. doi:10.1002/pon.3714CrossRefGoogle Scholar
Deimling, GT, Brown, SP, Albitz, C, et al. (2017) The relative importance of cancer-related and general health worries and distress among older adult, long-term cancer survivors. Psycho-Oncology 26(2), 182–190. doi:10.1002/pon.4015CrossRefGoogle ScholarPubMed
Delgado-Guay, M, Parsons, HA, Li, Z, et al. (2009) Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Supportive Care in Cancer 17(5), 573–579. doi:10.1007/s00520-008-0529-7CrossRefGoogle ScholarPubMed
Derks, MG, de Glas, NA, Bastiaannet, E, et al. (2016) Physical functioning in older patients with breast cancer: A prospective cohort study in the TEAM trial. Oncologist 21(8), 946–953. doi:10.1634/theoncologist.2016-0033CrossRefGoogle ScholarPubMed
Doig, GS and Simpson, F (2005) Randomization and allocation concealment: A practical guide for researchers. Journal of Critical Care 20(2), 187–191. doi:10.1016/j.jcrc.2005.04.005CrossRefGoogle ScholarPubMed
Dura-Ferrandis, E, Mandelblatt, JS, Clapp, J, et al. (2017) Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (alliance). Psycho-Oncology 26(11), 1914–1921. doi:10.1002/pon.4404CrossRefGoogle Scholar
Edwards, B and Ung, L (2002) Quality of life instruments for caregivers of patients with cancer: A review of their psychometric properties. Cancer Nursing 25(5), 342–349.CrossRefGoogle ScholarPubMed
Freeman, A (2004) Clinical Applications of Cognitive Therapy. New York: Springer.CrossRefGoogle Scholar
Fujii, M, Ohno, Y, Tokumaru, Y, et al. (2001) Manifest anxiety scale for evaluation of effects of granisetron in chemotherapy with CDDP and 5FU for head and neck cancer. Supportive Care in Cancer 9(5), 366–371.CrossRefGoogle ScholarPubMed
Gotze, H, Brahler, E, Gansera, L, et al. (2014) Psychological distress and quality of life of palliative cancer patients and their caring relatives during home care. Supportive Care in Cancer 22(10), 2775–2782. doi:10.1007/s00520-014-2257-5CrossRefGoogle ScholarPubMed
Gotze, H, Brahler, E, Gansera, L, et al. (2016) Anxiety, depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient's death. European Journal of Cancer Care. doi:10.1111/ecc.12606Google ScholarPubMed
Gough, K and Hudson, P (2009) Psychometric properties of the hospital anxiety and depression scale in family caregivers of palliative care patients. Journal of Pain and Symptom Management 37(5), 797–806. doi:10.1016/j.jpainsymman.2008.04.012CrossRefGoogle ScholarPubMed
Greer, JA, Pirl, WF, Park, ER, et al. (2008) Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer. Journal of Psychosomatic Research 65(6), 549–552. doi:10.1016/j.jpsychores.2008.03.005CrossRefGoogle ScholarPubMed
Greer, JA, Traeger, L, Bemis, H, et al. (2012) A pilot randomized controlled trial of brief cognitive-behavioral therapy for anxiety in patients with terminal cancer. Oncologist. doi:10.1634/theoncologist.2012-0041CrossRefGoogle ScholarPubMed
Grov, EK, Dahl, AA, Moum, T, et al. (2005) Anxiety, depression, and quality of life in caregivers of patients with cancer in late palliative phase. Annals of Oncology 16(7), 1185–1191. doi:10.1093/annonc/mdi210CrossRefGoogle ScholarPubMed
Holland, J (2016). Double whammy of cancer and aging. Personal Communication.Google Scholar
Hopwood, P, Howell, A and Maguire, P (1991) Screening for psychiatric morbidity in patients with advanced breast cancer: Validation of two self-report questionnaires. British Journal of Cancer 64(2), 353–356.CrossRefGoogle ScholarPubMed
Horney, DJ, Smith, HE, McGurk, M, et al. (2011) Associations between quality of life, coping styles, optimism, and anxiety and depression in pretreatment patients with head and neck cancer. Head & Neck 33(1), 65–71. doi:10.1002/hed.21407CrossRefGoogle ScholarPubMed
Huang, LW, Smith, AK and Wong, ML (2019) Who will care for the caregivers? Increased needs when caring for frail older adults with cancer. Journal of the American Geriatrics Society 67(5), 873–876. doi:10.1111/jgs.15863CrossRefGoogle ScholarPubMed
Hundt, NE, Amspoker, AB, Kraus-Schuman, C, et al. (2014) Predictors of CBT outcome in older adults with GAD. Journal of Anxiety Disorders 28(8), 845–850. doi:10.1016/j.janxdis.2014.09.012CrossRefGoogle ScholarPubMed
Kasparian, NA, McLoone, JK and Butow, PN (2009) Psychological responses and coping strategies among patients with malignant melanoma: A systematic review of the literature. Archives of Dermatology 145(12), 1415–1427. doi:10.1001/archdermatol.2009.308CrossRefGoogle ScholarPubMed
Kazantzis, N, Pachana, NA and Secker, DL (2003) Cognitive behavioral therapy for older adults: Practical guidelines for the use of homework assignments. Cognitive and Behavioral Practice 10(4), 324–332. doi:doi:10.1016/S1077-7229(03)80050-0CrossRefGoogle Scholar
Klepin, HD, Tooze, JA, Pardee, TS, et al. (2016) Effect of intensive chemotherapy on physical, cognitive, and emotional health of older adults with acute myeloid leukemia. Journal of the American Geriatrics Society 64(10), 1988–1995. doi:10.1111/jgs.14301CrossRefGoogle ScholarPubMed
Knight, BG and McCallum, TJ (1998) Adapting psychotherapeutic practice for older clients: Implications of the contextual, cohort-based, maturity, specific challenge model. Professional Psychology: Research and Practice 29(1), 15–22. doi:10.1037/0735-7028.29.1.15CrossRefGoogle Scholar
Kropf, N, Cummings, SM and Cummings, S (2017) Evidence-Based Treatment with Older Adults: Theory, Practice, and Research. New York: Oxford University Press.CrossRefGoogle Scholar
Lambert, S, Pallant, JF and Girgis, A (2011) Rasch analysis of the hospital anxiety and depression scale among caregivers of cancer survivors: Implications for its use in psycho-oncology. Psycho-Oncology 20(9), 919–925. doi:10.1002/pon.1803CrossRefGoogle ScholarPubMed
Latte-Naor, S and Mao, JJ (2019) Putting integrative oncology into practice: Concepts and approaches. Journal of Oncology Practice 15(1), 7–14. doi:10.1200/jop.18.00554.CrossRefGoogle ScholarPubMed
Lees, J and Chan, A (2011) Polypharmacy in elderly patients with cancer: Clinical implications and management. The Lancet Oncology 12(13), 1249–1257. doi:10.1016/s1470-2045(11)70040-7CrossRefGoogle ScholarPubMed
Luckett, T, Butow, PN, King, MT, et al. (2010) A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Supportive Care in Cancer 18(10), 1241–1262. doi:10.1007/s00520-010-0932-8CrossRefGoogle ScholarPubMed
Maher, RL, Hanlon, J and Hajjar, ER (2013) Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety. doi:10.1517/14740338.2013.827660Google ScholarPubMed
Mitchell, AJ (2010) Short screening tools for cancer-related distress: A review and diagnostic validity meta-analysis. Journal of the National Comprehensive Cancer Network 8(4), 487–494.CrossRefGoogle ScholarPubMed
Molton, IR and Terrill, AL (2014) Overview of persistent pain in older adults. American Psychology 69(2), 197–207. doi:10.1037/a0035794CrossRefGoogle ScholarPubMed
Moorey, S and Greer, S (2002) Cognitive Behaviour Therapy for People with Cancer. New York: Oxford University Press.Google Scholar
Moorey, S, Greer, S, Watson, M, et al. (1991) The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. British Journal of Psychiatry 158, 255–259.CrossRefGoogle ScholarPubMed
Moyer, A, Sohl, SJ, Knapp-Oliver, SK, et al. (2009) Characteristics and methodological quality of 25 years of research investigating psychosocial interventions for cancer patients. Cancer Treatment Reviews 35(5), 475–484. doi:10.1016/j.ctrv.2009.02.003CrossRefGoogle ScholarPubMed
National Alliance for Caregiving (2016) Cancer Caregiving in the U.S.: An Intense, Episodic, and Challenging Care Experience. Available at: https://www.caregiving.org/wp-content/uploads/2020/05/CancerCaregivingReport_FINAL_June-17-2016.pdf (accessed October 31, 2020).Google Scholar
National Alliance for Caregiving, AARP Public Policy Institute (2015) Caregiving in the U.S., 2015. Available at: https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf (accessed October 31, 2020).Google Scholar
Nelson, CJ, Balk, EM and Roth, AJ (2010) Distress, anxiety, depression, and emotional well-being in African-American men with prostate cancer. Psycho-Oncology 19(10), 1052–1060. doi:10.1002/pon.1659CrossRefGoogle ScholarPubMed
Nightingale, G, Hajjar, E, Swartz, K, et al. (2015) Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. Journal of Clinical Oncology 33(13), 1453–1459. doi:10.1200/jco.2014.58.7550CrossRefGoogle ScholarPubMed
Oh, PJ (2017) Predictors of cognitive decline in people with cancer undergoing chemotherapy. European Journal of Oncology Nursing 27, 53–59. doi:10.1016/j.ejon.2016.12.007CrossRefGoogle ScholarPubMed
Oken, MM, Creech, RH, Tormey, DC, et al. (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology 5(6), 649–655.CrossRefGoogle ScholarPubMed
Osborn, RL, Demoncada, AC and Feuerstein, M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. The International Journal of Psychiatry in Medicine 36(1), 13–34.CrossRefGoogle ScholarPubMed
Parpa, E, Tsilika, E, Gennimata, V, et al. (2014) Elderly cancer patients’ psychopathology: A systematic review: Aging and mental health. Archives of Gerontology and Geriatrics 60(1), 9–15. doi:10.1016/j.archger.2014.09.008CrossRefGoogle ScholarPubMed
Pedersen, AE, Sawatzky, JA and Hack, TF (2010) The sequelae of anxiety in breast cancer: A human response to illness model. Oncology Nursing Forum 37(4), 469–475. doi:10.1188/10.onf.469-475CrossRefGoogle ScholarPubMed
Prieto, JM, Blanch, J, Atala, J, et al. (2002) Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. Journal of Clinical Oncology 20(7), 1907–1917.CrossRefGoogle ScholarPubMed
Prithviraj, GK, Koroukian, S, Margevicius, S, et al. (2012) Patient characteristics associated with polypharmacy and inappropriate prescribing of medications among older adults with cancer. Journal of Geriatric Oncology 3(3), 228–237. doi:10.1016/j.jgo.2012.02.005CrossRefGoogle ScholarPubMed
Reddy, SK, Parsons, HA, Elsayem, A, et al. (2009) Characteristics and correlates of dyspnea in patients with advanced cancer. Journal of Palliative Medicine 12(1), 29–36. doi:10.1089/jpm.2008.0158CrossRefGoogle ScholarPubMed
Rossi Ferrario, S, Zotti, AM, Massara, G, et al. (2003) A comparative assessment of psychological and psychosocial characteristics of cancer patients and their caregivers. Psycho-Oncology 12(1), 1–7. doi:10.1002/pon.626CrossRefGoogle ScholarPubMed
Salvo, N, Zeng, L, Zhang, L, et al. (2012) Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer. Clinical Oncology 24(2), 139–148. doi:10.1016/j.clon.2011.05.003CrossRefGoogle ScholarPubMed
Schag, CA and Heinrich, RL (1989) Anxiety in medical situations: Adult cancer patients. Journal of Clinical Psychology 45(1), 20–27. doi:10.1002/1097-4679(198901)45:1<20::AID-JCLP2270450103>3.0.CO;2-Z3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Segrin, C, Badger, T, Dorros, SM, et al. (2007) Interdependent anxiety and psychological distress in women with breast cancer and their partners. Psycho-Oncology 16(7), 634–643. doi:10.1002/pon.1111CrossRefGoogle ScholarPubMed
Sklenarova, H, Krumpelmann, A, Haun, MW, et al. (2015) When do we need to care about the caregiver? Supportive care needs, anxiety, and depression among informal caregivers of patients with cancer and cancer survivors. Cancer 121(9), 1513–1519. doi:10.1002/cncr.29223CrossRefGoogle ScholarPubMed
Smith, EM, Gomm, SA and Dickens, CM (2003) Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer. Palliative Medicine 17(6), 509–513.CrossRefGoogle ScholarPubMed
Snaith, RP and Zigmond, AS (1986) The hospital anxiety and depression scale. British Medical Journal 292(6516), 344.CrossRefGoogle ScholarPubMed
Teunissen, SC, de Haes, HC, Voest, EE, et al. (2006) Does age matter in palliative care? Critical Reviews in Oncology/Hematology 60(2), 152–158. doi:10.1016/j.critrevonc.2006.06.002CrossRefGoogle ScholarPubMed
Trevino, KM, Stern, A and Prigerson, HG (2020) Adapting psychosocial interventions for older adults with cancer: A case example of Managing Anxiety from Cancer (MAC). Journal of Geriatric Oncology 11(8), 1319–1323. doi:10.1016/j.jgo.2020.03.012CrossRefGoogle Scholar
van Abbema, D, van Vuuren, A, van den Berkmortel, F, et al. (2017) Functional status decline in older patients with breast and colorectal cancer after cancer treatment: A prospective cohort study. Journal of Geriatric Oncology 8(3), 176–184. doi:10.1016/j.jgo.2017.01.003CrossRefGoogle ScholarPubMed
Watson, M, White, C, Lynch, A, et al. (2017) Telephone-delivered individual cognitive behavioural therapy for cancer patients: An equivalence randomised trial. Psycho-Oncology 26(3), 301–308. doi:10.1002/pon.4338CrossRefGoogle ScholarPubMed
Webster, K, Cella, D and Yost, K (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: Properties, applications, and interpretation. Health and Quality of Life Outcomes 1, 79. doi:10.1186/1477-7525-1-79CrossRefGoogle Scholar
Weitzner, MA, Jacobsen, PB, Wagner, H Jr. et al. (1999) The Caregiver Quality of Life Index-Cancer (CQOLC) scale: Development and validation of an instrument to measure quality of life of the family caregiver of patients with cancer. Quality of Life Research 8(1–2), 55–63.CrossRefGoogle ScholarPubMed
Westen, D and Morrison, K (2001) A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology 69(6), 875–899.CrossRefGoogle ScholarPubMed
Zhang, X, Sun, M, Liu, S, et al. (2018) Risk factors for falls in older patients with cancer. BMJ Supportive & Palliative Care 8(1), 34–37. doi:10.1136/bmjspcare-2017-001388CrossRefGoogle ScholarPubMed
Zigmond, AS and Snaith, RP (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67(6), 361–370.CrossRefGoogle ScholarPubMed