Holland's Research Focuses on Needs of Older Patients

Jimmie C. Holland, MD

When Jimmie C. Holland, MD, conducts research, geriatric cancer patients are often her focus.

In 2006, the doctor and her colleagues in the Cancer and Leukemia Group B (CALGB) studied telephone intervention as a way to monitor stress in patients aged 65 and older. The investigators found that, through telephone monitoring and subsequent referrals for mental-health support, they were able to reduce anxiety and depression in this population.

Why was a new technique needed for diagnosing distress in elderly chemotherapy outpatients?

The CALGB study that provided initial data on the efficacy of this approach was published in 2006.¹ What was the design of the study?

What did the study find?

What’s the latest focus of the project?

Seven years later, Holland continues to study the value of the technique and how it can best be implemented. She discussed the effort with OncologyLive.Older people are often more alone than they’d like to be, and it’s harder for them to come to the hospital when they’re not well. This system is designed for older people who are going through chemotherapy for a long time, to give them a series of educational sessions that deal with key issues they face, and to monitor how they’re doing.One hundred ninety-two older patients who were receiving treatment for advanced breast, prostate, or colorectal cancer were randomized to receive either printed educational materials alone, or educational materials supplemented by monthly telephone monitoring. Patients in the experimental arm who scored above a certain level on telephone questionnaires were referred to oncology nurses, who got them in touch with mental health professionals.At six months, based on the Hospital Anxiety and Depression Scale (HADS), patients in the telephone monitoring group reported significantly less anxiety [P < .0001], depression [P = .0004], and overall distress [P < .0001] compared with patients in the control group. We found this to be an efficient means of reducing anxiety and depression in this population.We’re conducting a clinical trial now [NCT00984321] in about 170 patients over 70 years old being treated for breast, prostate, lung, and gynecological cancers, as well as lymphoma, to compare this technique with our standard of care.

This time, we’re testing the technique in both group and individual phone counseling formats. We’re investigating the feasibility, tolerability, and acceptability of this kind of intervention by examining the rates of eligibility, acceptance, and adherence. Of course, we’re also looking at the impact in both formats on depression, anxiety, demoralization, coping, loneliness, isolation, and spirituality.

Patients who choose not to participate will be asked to take part in a brief refusal substudy—composed of two questionnaires— designed to compare distress levels in patients who join the main study and those who decline. This will help us distinguish between patients who decline due to a lack of interest in research and those who decline due to high levels of distress.

In the future, we’re also thinking of trying to offer this kind of intervention in some other way⎯perhaps online.

1. Kornblith AB, Dowell JM, Herndon JE II, et al. Telephone monitoring of distress in patients aged 65 years or older with advanced stage cancer: a Cancer and Leukemia Group B study. Cancer. 2006;107(11):2706-2714.