A Stepped Approach to Psychosocial Care in Head and Neck Cancer Is Cost-Effective

A four-step approach proved to be beneficial in offering psychosocial support to patients with head and neck cancer.
LAUREN M. GREEN @OncNurseEditor
PUBLISHED: DECEMBER 21, 2016
Talk about this article with other patients, caregivers, and advocates in the Head & Neck Cancer CURE discussion group.
Patients diagnosed with head and neck or lung cancer are especially prone to feelings of distress, especially depression, and researchers in the Netherlands have found that using a gradual or “stepped” approach to providing psychosocial support not only improves their quality of life, but is also cost-effective.
 
A team of investigators at the Vu Medical Center in Amsterdam sought to determine the cost-utility of a psychosocial intervention based on a stepped care (SC) model, whereby patients proceed to the next level of care only when their symptoms don’t resolve.
 
The approach involves four steps: (1) watchful waiting; (2) guided self-help via the Internet or a booklet; (3) face-to-face problem-solving therapy; and (4) specialized psychological interventions and/or psychotropic medication.
 
Prior cost-effectiveness studies of SC programs have shown that they improve quality-adjusted life years (QALYs) or the number of days without depression when compared with care as usual (CAU) controls, but these have been limited to primary care and older patients, as well as those with diabetes. The cost utility of the SC model has not yet been examined in patients with cancer, the researchers noted in their cost analysis, published online in the Journal of Clinical Oncology.
 
To determine eligibility for the randomized controlled trial upon which this cost utility analysis was based, patients with head and neck or lung cancer were screened for symptoms of distress, anxiety or depression, using the Hospital Anxiety and Depression Scale (HADS). A total of 265 eligible patients with elevated HADS scores were identified; after excluding those who didn’t want to participate or were unable to be reached, 156 patients were randomized to either SC (75 patients) or CAU (81 patients).
 
The efficacy of the SC model in this trial was analyzed and reported in the Annals of Oncology. Overall, investigators reported that patients with untreated distress in the SC group scored better than controls on the HADS, with recovery rates of 55 percent versus 29 percent, respectively, posttreatment, and 46 percent versus 37 percent, at the 12-month follow-up. Over the course of the four steps, 28 percent of those in the SC group improved after watchful waiting, 34 percent following the guided self-help, 9 percent after step 3 (problem-solving) and 17 percent after receiving psychotherapy and/or psychotropic medication.
 
For the study reported here, investigators evaluated the intervention’s economic value by calculating the mean cumulative costs and mean number of patient QALYs. The mean cumulative cost figure is based on several variables, including the cost of healthcare use and medication (direct medical costs), cost of psychological help, direct nonmedical costs (eg, support groups, transportation, and parking) and indirect nonmedical costs such as loss of productivity from employment due to absenteeism or working while in poor health.
 
Five follow-up assessments were conducted in each arm: Patients in the SC group were evaluated after completing stepped care, and three, six, nine and 12 months later. Usual care participants were assessed at four months, and then at the same four follow-up time points as the intervention arm.
 


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