Phone Counseling May Help With Cancer Pain, Depression

Article date: October 8, 2010

By Rebecca V. Snowden

Many cancer patients suffer from undetected, undertreated cancer-related pain and depression. Phone counseling and automated symptom monitoring may help change that, according to a study published recently in the Journal of the American Medical Association (JAMA).

“Because oncologists are busy with testing, chemotherapy, and other treatments, they often have too little time left for quality of life issues, like pain and depression,” said Kurt Kroenke, MD, professor medicine at the Indiana University School of Medicine and lead author of the study. “We felt one solution might be a partnership between a telephone-based symptom management team and community-based oncology practices.”

What this study found

To test this solution, researchers from the Regenstrief Institute and Indiana University School of Medicine recruited 405 cancer patients who were experiencing pain, depression, or both and separated them into 2 groups. One group received usual care (results of their pain and depression tests were given to their oncologists, but the researchers did not do any follow-up), and the other group received regular phone calls from nurses trained to recognize pain and depression symptoms. That group was also monitored via automated, interactive phone calls or Web surveys.

“Technology, in the form of automated calls repeated until an adequate treatment response occurred, allowed us to gather data on symptom severity at a time convenient for the patient, making the process very patient-centered,” said Kroenke.

“It also allowed the nurse manager to work at a higher level to improve the quality of life of these cancer patients. And it gave these patients, many of whom lived in underserved rural areas, one stop assistance they probably wouldn’t have had access to unless they went to a major cancer center.”

The results were promising. Over 12 months, patients in the phone-counseling group saw greater improvement in their symptoms than people in the usual care group, regardless of whether they were suffering from pain or depression. Improvements were also seen across the board in patients with all types of cancers and in both rural and urban communities.

However, there were some limitations to the study. The researchers didn’t collect the data by cancer type, so there may be some variation in the program’s effectiveness depending on the cancer being treated. Also, the researchers didn’t collect data on cost-effectiveness. More research is needed, the study authors write.

If you have cancer-related pain or depression

If you have cancer-related pain, talk with your doctor or nurse about it -- where it is, when it began, how long it lasts, what it feels like, what makes it better or worse, and how it affects your life. A pain diary can help you keep track of these details. If your prescribed pain medicines don’t work as expected, let your doctor or nurse know. If your pain increases, call your doctor.

Pain and depression often go hand-in-hand. Some symptoms of depression include having a sad or empty mood most of the day, loss of interest in activities you once enjoyed, eating problems (loss of appetite or overeating), sleep changes (either too much or too little), loss of energy, among others. If you think you’re depressed, talk with your doctor or consider working with a professional counselor.

Caregivers can play an important role in helping doctors and nurses identify pain and depression. Don’t be afraid to speak up. If you notice any of these symptoms in your loved one, be sure to report them to his or her health care team.

For more information on recognizing, coping with, and addressing the side effects of cancer, whether you’re in treatment for cancer or you’re taking care of someone with cancer, see Caring for the Cancer Patient at Home.