Depression & Adherence in Head and Neck Cancer

描述(由申请人提供)： 这项拟议研究的主要目的是开发和试点对接受放射治疗的抑郁口咽癌患者进行抑郁的家庭干预。干预将由十次会议组成，其中大部分将通过电话进行，并辅之以认知行为结构化日志。试点干预还将把认知-行为技术应用于与这一患者群体相关的其他问题，即酒精依赖，以便加强抑郁症患者的支持系统，还将向患者的伴侣或照顾者提供有关抑郁症的性质、过程和治疗的心理教育内容。第二个目的是确定抑郁的改善是否与口咽癌患者坚持康复方案有关，这些康复方案包括防止肌肉纤维化和维持正常饮食的吞咽运动，以及防止口腔感染和放射性骨坏死的口腔卫生常规。 这项可行性研究将采用一组前瞻性设计，从放射治疗开始到12周后跟踪40名口咽部抑郁患者。计划进行两次后续评估，在干预完成时基线后六周，以及六周后再次评估。将测量患者的招募和拒绝率、满意度、问卷完成率和辍学率。一项测试干预措施在减轻抑郁方面的有效性的推论分析将比较抑郁前后的水平。次要结果变量将包括自控力，就像雷姆的抑郁和生活质量模型中所规定的那样。疼痛、疲劳和社会支持将作为干预对抑郁水平的潜在影响的中介进行测试。

DESCRIPTION (provided by applicant): The primary purpose of the proposed research is to develop and pilot test an in-home intervention for depression in depressed oropharyngeal cancer patients receiving radiation treatment. The intervention will be comprised of ten sessions, the bulk of which will be delivered over the telephone, supplemented with a cognitive behavioral structured journal. The pilot intervention will also apply cognitive-behavioral techniques to other issues relevant to this patient population, namely alcohol dependence, where relevant, in order to strengthen the depressed patient's support system, the patient's partner or caregiver will also be offered a psychoeducational component on the nature, course, and treatment for depression. A secondary purpose is to determine whether improvement in depression is related to oropharyngeal cancer patient's adherence to rehabilitative regimens, including swallowing exercises to prevent fibrosis of musculature and maintain normalcy of diet, and oral hygiene routines to prevent infections in the oral cavity and osteoradionecrosis. This feasibility study will use a one-group prospective design following 40 depressed oropharyngeal patients from the beginning of radiation treatment until twelve weeks later. Two follow-up assessments are planned, six weeks after baseline when the intervention will be completed, and again six weeks later. Patients' recruitment and refusal rates, satisfaction, questionnaire completion rates, and dropout will be measured. An inferential analysis testing the efficacy of the intervention in reducing depression will compare pre-and post-levels of depression. Secondary outcome variables will include self-control, as specified in Rehm's model of depression and quality of life. Pain, fatigue, and social support will be tested as mediators of the intervention's potential effect on depression levels.