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(OAC；≥65岁，≥1年后- 治疗)有临床上显著的抑郁症。目前，%的癌症幸存者是65岁的≥， 到2040年，这一数字将增加到73%。因此，抑郁症患者的数量将超过600万，因为 美国人口继续老龄化。即使OAC继续治疗抑郁症，他们也可能得不到 适合发展的服务，因为老年精神卫生工作人员太少，无法满足 满足不断增长的人口对肿瘤学的需求。因此，OAC是未经治疗的独特的高危人群。 抑郁症需要新的、可广泛传播的治疗策略。然而，还没有研究评估 通过癌症存活期诊所为老年人实施循证抑郁症治疗。这个 目前的建议采用实施科学框架来针对OACS中的抑郁。萨拉西诺医生 建议调整行为激活(BA)作为一种有前景的、直接的治疗方法，以增加 OACS参与以证据为基础的抑郁症治疗。使用探索性的序贯混合方法 设计，包括小型开放试验和随机对照试验，本研究有三个具体目的：1)获得 来自关键利益相关者(例如，OAC、社会工作者、生存诊所临床医生)的反馈意见，以修订BA 手册内容和程序，并发展对OACS治疗参与的障碍的理解； 2)评价执行成果(即适当性、可接受性、采纳性、可行性、忠诚度、 BA在癌症生存中的渗透性和可持续性)；以及3)确定BA的初步效果 关于抑郁(主要结果)、焦虑、应对和行为激活(次要结果)的比较 至支持性心理治疗(SP)控制臂。该项目的完成将有助于萨拉西诺博士长期 职业目标是成为一名在传播和实施方面具有专业知识的独立调查员 (d&i)对癌症轨道上的老年人进行心理健康筛查和治疗。在一个 拥有一支由国内和国际专家组成的强大的指导团队，提供支持性的、丰富的环境。 萨拉西诺将在5个方面接受高级培训，这对她作为独立调查员的成功至关重要：1) 癌症存活期；2)老年心理健康研究；3)D&I科学；4)混合方法；5) 纵向数据分析。萨拉西诺博士概述了一项全面的5年培训计划，其中包括指导 辅导、正式课程、研讨会、在线培训、国家会议和实践研究活动 这与她的训练目标直接平行。这项建议是对NCI对癌症研究的呼吁的回应 幸存者和老年人，以及癌症登月倡议蓝丝带小组工作组 实施科学的建议，即应就如何量身定做进行实施研究 并在多个层面(如个人、提供者、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.