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

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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.