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 通过癌症幸存者诊所对老年人实施循证抑郁症治疗。的 目前的研究采用了一个实施科学的框架，以目标抑郁症在OACS。萨拉西诺医生提议 适应行为激活（BA）作为一个有前途的，直接的治疗，以增加OACS的 参与循证抑郁症治疗。采用探索性序贯混合方法设计， 本研究包括一个小型的开放性试验和随机对照试验，具体目的有三个：1）获得反馈 关键利益相关者（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治疗参与的障碍; 2）评估 执行成果（即，适当性、可接受性、采用性、可行性、忠实性、渗透性，以及 BA在癌症生存中的可持续性）; 3）确定BA对抑郁症的初步影响 （主要结局），焦虑，应对和行为激活（次要结局）与支持性 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， 成为一个独立的调查员，在传播和实施（D&I）的精神 健康检查和治疗的老年人在整个癌症轨迹。在一个支持性的背景下， 丰富的环境与强大的导师团队的国家和国际专家，萨拉西诺博士将 继续在5个领域获得高级培训，这对她作为独立研究者的成功至关重要：1）癌症 生存率; 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. Saracino博士正在完成一项为期5年的全面培训计划，其中包括指导指导，正式的 课程，研讨会，在线培训，国家会议和实践研究活动， 与她的训练目标一致这一补充和详细的计划，以恢复充分生产后，产假 将允许Saracino博士继续努力成为一名独立的研究者，并获得R 01资金， 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.