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 目前的研究采用了实施科学框架来针对OACS中的抑郁。萨拉西诺博士建议 适应行为激活(BA)作为一种有希望的、直接的治疗方法来增加OAC 参与循证抑郁症治疗。使用探索性顺序混合方法设计， 本研究包括小型开放试验和随机对照试验，有三个具体目的：1)获取反馈 从关键利益相关者(例如，OAC、社会工作者、生存诊所临床医生)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)评估 实施结果(即适当性、可接受性、采用率、可行性、保真度、渗透率和 BA在癌症生存中的可持续性；以及3)确定BA对抑郁症的初步作用 (主要结果)、焦虑、应对和行为激活(次要结果)与支持性结果 心理治疗(SP)控制臂。该项目的完成将促进萨拉西诺博士的长期职业目标 成为具有传播和实施(D&I)精神的专门知识的独立调查员 对癌症轨迹中的老年人进行健康筛查和治疗。在支持性的背景下， 拥有一支由国内和国际专家组成的强大的指导团队，萨拉西诺博士将 继续接受5个领域的高级培训，这些培训对她作为独立调查员的成功至关重要：1)癌症 生存；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。萨拉西诺博士正在完成一项全面的5年培训计划，其中包括正式的指导性指导 课程、研讨会、在线培训、国家会议和实践研究活动，直接 与她的训练目标平行。这份补充材料和详细的产假后恢复生产的详细计划 将使萨拉西诺博士继续努力成为一名拥有R01资金的独立调查员 最小的干扰。

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-based depression treatment forolder adults through cancer survivorship clinics. The current study adopts an implementation science framework to target depressionin 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 international experts, Dr. Saracino will continue to 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 is completing a comprehensive 5-year training plan that includes guided mentoring, formal coursework, seminars, online trainings, national conferences, and hands-on research activities that directly parallel her training goals. This supplement and detailed plans for return to full productivity after maternity leave will allow Dr. Saracino to continue to work towards becoming an independent investigator with R01 funding with minimal disruption.