Cancer and Aging Reflections for Elders (CARE): A Geriatric-Specific Psychotherapy for Older Adults with Cancer

项目总结 到2040年，20%的人口将超过65岁。60%的癌症诊断和70%的癌症死亡 发生在老年人中，农村老年人患癌症和死于癌症的风险比城市老年人高 同伴们。此外，73%的癌症幸存者是老年人。抑郁症是老年人的一个重要问题。 对于癌症，据估计，那些有抑郁症状的人高达27%。抑郁经常会干扰 有治疗决策和治疗依从性。在农村地区，高达25%的老年人患有 可诊断的精神疾病。此外，老年人通常患有亚综合征抑郁症，最近 据估计，在患有内科疾病的患者中，人口比例高达40%。即使出现轻微的抑郁症状也是 与显著的死亡率有关。这些人面临更高的社会孤立风险， 获得精神卫生保健的机会，尽管有利用这些服务的意愿。我们开发了一种新的干预方法， 癌症与老龄化：老年人(CARE)干预治疗老年人抑郁和痛苦的思考 癌症患者。CARE是一种手动的、五次电话干预，很容易传播。 CARE独特地关注衰老和癌症的各个方面：1)将老龄化的发展理论与 重新评估理论，以及2)纳入老年癌症患者的反馈。这件独特的裁缝是专门设计的 帮助老年人协商特定年龄的发展任务，并利用对以下方面重要的重新评估策略 成功老化。因此，护理有可能比标准的“现成”更有效 心理治疗干预，适用于这一人群。来自试点RCT的数据表明，CARE是 可行有效。本研究在一项大型双臂随机对照试验中测试护理干预的效果。我们会 与癌症支持社区(CSC)合作，通过CSC的当地分支机构在 并通过CSC确定的社会工作者通过电话提供干预措施。476 受试者将被随机分配到两个手臂：手臂1-护理干预和手臂2-社会工作和 支持性咨询(SWSC)干预。这两次发言将包括5次会议(45分钟)和4次简报 强化训练(30分钟)。CARE有可能在理论和临床层面上影响该领域。 重要的是，护理是通过电话测试的，以接触到地理上与世隔绝的老年人 培养了不同类型的专业人员(例如，硕士级别的心理学家、社会工作者、神职人员、 精神科护士)可以提供干预。如果被发现是有效的，护理可能是一种成本效益高的，很容易- 为患有癌症的老年人实施抑郁症状的一线治疗。

PROJECT SUMMARY By 2040, 20% of the population will be over 65. Sixty percent of cancer diagnoses and 70% of cancer deaths occur in older adults, with rural older adults at a higher risk of developing and dying from cancer than their urban peers. Additionally, 73% of cancer survivors are older adults. Depression is an important concern for older adults with cancer, as estimates of those with depressive symptoms are as high as 27%. Depression often interferes with treatment decision making and treatment adherence. In rural areas, up to 25% of older adults have a diagnosable psychiatric illness. Additionally, older adults often have subsyndromal depression, with recent population estimates of up to 40% in medically ill patients. Even the presence of mild depressive symptoms is associated with significant mortality. These individuals are at increased risk for social isolation with minimal access to mental health care despite a willingness to utilize these services. We developed a novel intervention, the Cancer and Aging: Reflections for Elders (CARE) Intervention, to treat depression and distress in older cancer patients. CARE is a manualized, five session telephone intervention which can easily be disseminated. CARE uniquely focuses on aspects of aging and cancer by: 1) integrating development theory of aging with reappraisal theory, and 2) incorporating feedback from older cancer patients. This unique tailoring is designed to help older adults negotiate age specific developmental tasks and utilize reappraisal strategies important for successful aging. As a result, CARE has the potential to be more effective than “off the shelf,” standard psychotherapeutic interventions, applied to this population. Data from the pilot RCT indicated that CARE is feasible and effective. This study tests the efficacy of the CARE intervention in a large, two arm, RCT. We will partner with the Cancer Support Community (CSC) to recruit through CSC’s local affiliates in areas with large rural populations and to deliver the interventions via telephone through the CSC-identified social workers. 476 subjects will be randomly assigned to two arms: Arm 1-the CARE Intervention and Arm 2- a Social Work and Supportive Counseling (SWSC) Intervention. Both interventions will consist of 5 sessions (45 mins) and 4 briefer booster sessions (30 mins). CARE has the potential to impact the field on both a theoretical and clinical level. Importantly, CARE was tested by phone to reach older adults who are geographically isolated and was developed so different types of professionals (e.g., master’s level psychologists, social workers, clergy, psychiatry nurses) could provide the intervention. If found to be effective, CARE could be a cost effective, easily- implemented, first-line treatment for depressive symptoms for older adults with cancer.