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Managing Anxiety from Cancer (MAC): A pilot randomized controlled trial of an anxiety intervention for older adults with cancer and their caregivers

Published online by Cambridge University Press:  05 April 2021

Kelly M. Trevino Open the ORCID record for Kelly M. Trevino [Opens in a new window] ,
Amy Stern ,
Robin Hershkowitz ,
Soo Young Kim ,
Yuelin Li ,
Mark Lachs  and
Holly G. Prigerson
Kelly M. Trevino*
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY
Amy Stern
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY Weill Cornell Medicine,New York, NY
Robin Hershkowitz
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY New York Medical College, Valhalla, NY
Soo Young Kim
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY
Yuelin Li
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center,New York, NY
Mark Lachs
Affiliation:
Weill Cornell Medicine,New York, NY NewYork-Presbyterian Hospital, New York, NY
Holly G. Prigerson
Affiliation:
Weill Cornell Medicine,New York, NY NewYork-Presbyterian Hospital, New York, NY
*
Author for correspondence: Kelly M. Trevino, 641 Lexington Ave., 7th Floor, New York, NY 10065, USA. E-mail: trevinok@mskcc.org
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Abstract

Objective

Anxiety is common in older adults with cancer (OACs) and their caregivers and is associated with poor outcomes including worse physical symptoms, poor treatment adherence and response, and longer hospitalizations. This study examined the feasibility, acceptability, adherence, and preliminary efficacy of a cognitive-behavioral therapy (CBT) intervention for OACs and their caregivers.

Method

Patients with active cancer age 65 years and older and their caregivers were randomized to Managing Anxiety from Cancer (MAC), a seven-session CBT-based psychotherapy intervention delivered over the telephone or usual care. Patients and caregivers completed the intervention separately with licensed social workers. Self-report measures of anxiety, depression, and quality of life were administered after randomization and following intervention completion. Analyses were conducted separately for patients and caregivers and at the dyad level. Hierarchical Linear Modeling accounted for the within-dyad intraclass correlation coefficients (ICCs) by random intercepts associated with the dyads.

Results

Twenty-nine dyads were randomized; 28 (96.6%) patients and 26 (89.7%) caregivers completed all study procedures. Of dyads randomized to MAC, 85.7% (n = 12) of patients and caregivers completed all seven sessions. Most patients (≥50%) and over 80% of caregivers rated the overall intervention and intervention components as “moderately” to “very” helpful. MAC was associated with a greater reduction in anxiety among dyads than usual care, the effect of MAC was greater in caregivers than in patients, and improvement in patient anxiety was associated with the reduction in caregiver anxiety. However, these results did not reach statistical significance.

Significance of results

This pilot study demonstrates the feasibility of MAC and suggests strategies for improving acceptability, with a focus on adherence. Furthermore, these results indicate that MAC is promising for the reduction of anxiety in OAC–caregiver dyads and may be particularly beneficial for OAC caregivers. Larger randomized controlled trials are needed to evaluate the efficacy of MAC.

Keywords

AnxietyCancerCaregiverCognitive-behavioral therapyOlder adult
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 2 , April 2021 , pp. 135 - 145
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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