Age and depressive symptomatology: impact on the relative effectiveness of two pain and fatigue control interventions among cancer patients

Summary Pain and fatigue are among the most frequently occurring symptoms experienced by patients with cancer. Numerous studies have described the impact these symptoms can have on patients’ physical and psychological functioning as well as quality of life throughout the trajectory of the cancer experience. Recent research has focused on different types of interventions to control cancer symptoms. Prominent among these are nurse administered interventions and automated telephone interventions. In this study we investigated whether, in the presence of high (low) depression at intake, a nurse administered symptom management intervention (NASM) was more effective than an automated telephone symptom management intervention (ATSM) in the reduction of cancer pain and fatigue. Secondly, we investigated whether NASM was more effective than ATSM in the reduction of cancer pain and fatigue among older versus younger patients. Three hundred fifty-one patients were recruited who had been diagnosed with a solid tumor cancer or non-Hodgkin’s lymphoma. These patients were randomly assigned to NASM (180) and ATSM (171). Separate ANCOVA models for predicting pain and fatigue showed that there was no difference in the effectiveness of NASM and ATSM in controlling either pain or fatigue, based on level of depression at intake. However, the ATSM intervention outperformed the NASM intervention in controlling severity of fatigue among younger patients, while NASM outperformed ATSM in controlling pain among older patients. These findings point in the direction that oncologists, when identifying the appropriate style of intervention for an individual patient, may need to determine, in consultation with the patient, which symptoms should receive the highest priority, and what approach would feel most comfortable to them, so that optimal symptom control can be achieved.