Behavioral Activation for Depression in Older Adult Cancer Survivors: Pilot Randomized Control Trial and Implementation Outcomes

项目摘要/摘要：多达35%的老年癌症幸存者（OACS; ≥65岁，≥1年后， 治疗）有临床意义的抑郁症。目前，64%的癌症幸存者年龄≥65岁， 到2040年，这一数字将增加到73%。因此，抑郁的OACS数量将超过600万， 美国人口继续老龄化。即使OACS追求抑郁症治疗，他们可能不会收到 发展适当的服务，因为老年精神卫生工作人员太少，无法满足 这一日益增长的人群在肿瘤学方面的需求。因此，OACS是一个独特的未经治疗的高风险群体。 抑郁症需要新的，广泛传播的治疗策略。然而，没有研究评估了 通过癌症生存诊所为老年人实施循证抑郁症治疗。的 目前的建议采用了一个实施科学框架，以目标抑郁症的OACS。萨拉西诺医生 提出了适应行为激活（BA）作为一个有前途的，直接的治疗，以增加 OACS参与循证抑郁症治疗。采用探索性序贯混合方法 设计，包括一个小型的开放性试验和随机对照试验，本研究有三个具体目的：1）获得 关键利益攸关方的反馈（即，OACS、社会工作者、生存诊所临床医生）修订BA 手册内容和程序，并了解OACS中治疗参与的障碍; 2)评价执行结果（即，适当性、可接受性、采用性、可行性、忠实性， 渗透性和可持续性）; 3）确定BA对癌症存活率的初步影响 抑郁（主要结局）、焦虑、应对和行为激活（次要结局） 支持性心理治疗（SP）控制臂。该项目的完成将有助于Saracino博士的长期 职业目标是成为一名在传播和实施方面具有专门知识的独立调查员 （D&I）的心理健康筛查和治疗的老年人跨越癌症轨迹。的上下文中 支持，丰富的环境与强大的导师团队的国家和国际专家，博士。 Saracino将在5个领域获得高级培训，这对她作为独立调查员的成功至关重要： 癌症存活率; 2）老年心理健康研究; 3）D&I科学; 4）混合方法;和5） 纵向数据分析。Saracino博士概述了一个全面的5年培训计划，其中包括指导 指导、正式课程、研讨会、在线培训、全国会议和实践研究活动 与她的训练目标直接相关这项建议是响应国家癌症研究所对癌症研究的呼吁 生存和老年人，以及癌症登月计划蓝带小组工作组， 执行科学建议，应进行执行研究，研究如何调整 并在多个层面（如个人、供应商、系统、社区）部署循证干预措施 并在不同的临床和社区环境中最大限度地控制症状。

Project Summary/Abstract: As many as 35% of older adult cancer survivors (OACS; ≥65 years, ≥1-year post- treatment) have clinically significant depression. Presently, 64% of cancer survivors are ≥65 years old, and that number will increase to 73% by the year 2040. Thus, the number of depressed OACS will exceed 6 million as the U.S. population continues to age. Even if OACS pursue depression treatment, they may not receive developmentally appropriate services because the geriatric mental health workforce is too small to meet the needs of this growing population in oncology. Therefore, OACS are a uniquely high-risk group for untreated depression in need of novel, widely disseminable treatment strategies. Yet, no studies have evaluated the implementation of evidence-baseddepression treatment for older adults through cancersurvivorship clinics. The current proposal adopts an implementation science framework to target depression in OACS. Dr. Saracino proposes the adaptation of Behavioral Activation (BA) as a promising, straightforward treatment to increase OACS’ engagement in evidence-based depression treatment. Using an exploratory sequential mixed methods design, including a small open pilot and randomized control trial, this study has three specific aims: 1) To obtain feedback from key stakeholders (i.e., OACS, social workers, survivorship clinic clinicians ) to revise the BA manual content and procedures and develop an understanding of barriers to treatment engagement in OACS; 2) To evaluate implementation outcomes (i.e., appropriateness, acceptability, adoption, feasibility, fidelity, penetration, and sustainability) of BA in cancer survivorship; and 3) To determine the preliminary effects of BA on depression (primary outcome), anxiety, coping, and behavioral activation (secondary outcomes) compared to a Supportive Psychotherapy (SP) control arm. Completion of this project will facilitate Dr. Saracino’s long term career goal of becoming an independent investigator with expertise in the dissemination and implementation (D&I) of mental health screening and treatment for older adults across the cancer trajectory . In the context of a supportive, enriching environment with a strong mentorship team of national and inte rnational experts, Dr. Saracino will acquire advanced training in 5 areas critical to her success as an independent investigator: 1) Cancer Survivorship; 2) Geriatric Mental Health Research; 3) D&I Science; 4) Mixed Methods; and 5) Longitudinal Data Analysis. Dr. Saracino has outlined a comprehensive 5-year training plan that includes guided mentoring, formal coursework, seminars, onlinetrainings, national conferences, and hands-on researchactivities that directly parallel her training goals. This proposal is responsive to the NCI’s call for research on cancer survivorship and older adults, and the Cancer Moonshot Initiative Blue Ribbon Panel Working Group on Implementation Science’s recommendation that implementation research should be conducted on how to tailor and deploy evidence-based interventions at multiple levels (e.g. individuals, providers, systems, communities) and in different clinical and community settings to maximize symptom control.