Cancer and Aging Reflections for Elders (CARE): A Geriatric-Specific Psychotherapy for Older Adults with Cancer

项目摘要 到2040年，20%的人口将超过65岁。60%的癌症诊断和70%的癌症死亡 发生在老年人中，农村老年人患癌症和死于癌症的风险高于城市老年人。 同龄人73%的癌症幸存者是老年人。抑郁症是老年人的一个重要问题 据估计，有抑郁症状的人高达27%。抑郁症往往会干扰 治疗决策和治疗依从性。在农村地区，高达25%的老年人患有 可诊断的精神疾病此外，老年人往往有亚综合征抑郁症，最近 估计高达40%的医学疾病患者。即使是轻度抑郁症状的存在， 与显著的死亡率相关。这些人在社会孤立的风险增加， 获得精神卫生保健，尽管愿意利用这些服务。我们开发了一种新的干预措施， 癌症与衰老：老年人反思（CARE）干预，治疗老年人的抑郁和痛苦 癌症患者。CARE是一个手动的，五个会议的电话干预，可以很容易地传播。 CARE通过以下方式独特地关注衰老和癌症方面：1）将衰老的发展理论与 再评价理论，2）纳入老年癌症患者的反馈。这种独特的剪裁设计 帮助老年人协商特定年龄的发展任务，并利用重要的重新评估策略， 成功的衰老因此，CARE有可能比“现成的”标准更有效。 心理治疗干预，适用于这一人群。来自试点RCT的数据表明，CARE 可行性和有效性本研究在一项大型双臂随机对照试验中测试了CARE干预的有效性。我们将 与癌症支持社区（CSC）合作，通过CSC在大型地区的当地分支机构招募 通过社区支助委员会指定的社会工作者，通过电话提供干预措施。476 受试者将被随机分配到两个组：第1组-CARE干预和第2组-社会工作， 支持性咨询（SWSC）干预。两次干预都将包括5次会议（45分钟）和4次简报 助推器会议（30分钟）。CARE有可能在理论和临床层面上影响该领域。 重要的是，CARE通过电话进行了测试，以接触地理上孤立的老年人， 开发了如此不同类型的专业人员（例如，硕士水平的心理学家，社会工作者，神职人员， 精神科护士）可以提供干预。如果发现是有效的，护理可以是一个成本效益，很容易- 实施，一线治疗老年癌症患者的抑郁症状。

PROJECT SUMMARY By 2040, 20% of the population will be over 65. Sixty percent of cancer diagnoses and 70% of cancer deaths occur in older adults, with rural older adults at a higher risk of developing and dying from cancer than their urban peers. Additionally, 73% of cancer survivors are older adults. Depression is an important concern for older adults with cancer, as estimates of those with depressive symptoms are as high as 27%. Depression often interferes with treatment decision making and treatment adherence. In rural areas, up to 25% of older adults have a diagnosable psychiatric illness. Additionally, older adults often have subsyndromal depression, with recent population estimates of up to 40% in medically ill patients. Even the presence of mild depressive symptoms is associated with significant mortality. These individuals are at increased risk for social isolation with minimal access to mental health care despite a willingness to utilize these services. We developed a novel intervention, the Cancer and Aging: Reflections for Elders (CARE) Intervention, to treat depression and distress in older cancer patients. CARE is a manualized, five session telephone intervention which can easily be disseminated. CARE uniquely focuses on aspects of aging and cancer by: 1) integrating development theory of aging with reappraisal theory, and 2) incorporating feedback from older cancer patients. This unique tailoring is designed to help older adults negotiate age specific developmental tasks and utilize reappraisal strategies important for successful aging. As a result, CARE has the potential to be more effective than “off the shelf,” standard psychotherapeutic interventions, applied to this population. Data from the pilot RCT indicated that CARE is feasible and effective. This study tests the efficacy of the CARE intervention in a large, two arm, RCT. We will partner with the Cancer Support Community (CSC) to recruit through CSC’s local affiliates in areas with large rural populations and to deliver the interventions via telephone through the CSC-identified social workers. 476 subjects will be randomly assigned to two arms: Arm 1-the CARE Intervention and Arm 2- a Social Work and Supportive Counseling (SWSC) Intervention. Both interventions will consist of 5 sessions (45 mins) and 4 briefer booster sessions (30 mins). CARE has the potential to impact the field on both a theoretical and clinical level. Importantly, CARE was tested by phone to reach older adults who are geographically isolated and was developed so different types of professionals (e.g., master’s level psychologists, social workers, clergy, psychiatry nurses) could provide the intervention. If found to be effective, CARE could be a cost effective, easily- implemented, first-line treatment for depressive symptoms for older adults with cancer.