Increasingly, cancer care respects the fact that a patient's body is only part of the system that requires treatment. Over a third of cancer patients experience psychosocial distress - the mental health consequences of their conditions. And, increasingly, care providers are exploring phone- and internet-based interventions to help cancer patients navigate mental health challenges. A University of Colorado Cancer Center study recently published in the journal Psycho-Oncology asks an important question: after decades of use and study, can we definitely show that remote interventions improve psychosocial outcomes in cancer survivors, or might there be a required, in-person component of these interventions?
"The answer is that we really don't know yet," says Sonia Okuyama, MD, investigator at the CU Cancer Center and the paper's first author.
The small sample sizes of most studies, focus on non-Hispanic white patients (predominantly in breast cancer), varied design of the phone interventions offered, and lack of consistency in adhering to reporting guidelines means that despite a high number of published studies, few definitive findings are possible. In this study, a systematic database search for articles describing telephone interventions for adult cancer patients returned only 20 randomized controlled trials. Eight of these 20 studies showed significant improvement, but "these were typically not robust across multiple end points within the same study nor were these effects robust across studies that shared the same or similar end points," the paper writes.
"From this data, we simply can't tell whether these interventions work and in what situations they are most likely to be effective," Okuyama says.
One commonality in studies that reported positive results was the use of trained counselors to deliver phone interventions.
"Often it's nurses or peers who end up on the phone delivering the care," Okuyama says, "but it seems important to make sure the person delivering the intervention has specific training. Counseling cancer patients seems to be a highly specialized skill."
In the researchers' opinion, this paper highlights the urgent need for a well-designed large multi-center trial to definitively answer the question whether phone interventions can improve the psychosocial functioning of cancer survivors.
"We've spent significant time and funding dollars doing small studies without rigorous control," Okuyama says. "It's time we did this the right way, once, so that we could discover the effectiveness or lack of effectiveness of these interventions once and for all moving forward."