A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression among Low-Income Women

BackgroundWomen from low-income, racial/ethnic minority backgrounds receive fewer cancer screenings than other women and have higher rates of depression, which can interfere with cancer screening participation. ObjectiveAssess the comparative effectiveness of two interventions to improve breast, cervical, and colorectal cancer screening and reduce depression among underserved women with depressive symptoms. DesignRandomized comparative effectiveness trial SettingSix Federally Qualified Health Centers ParticipantsN=757, 50-64 years with depression symptoms and overdue for cancer screening. InterventionsParticipants were randomized to collaborative depression care plus cancer screening intervention (Collaborative Care Intervention, CCI) or cancer screening intervention alone (Prevention Care Management, PCM). Both of these evidence-based, telephone interventions were delivered in English or Spanish, for up to 12 months, by care managers. MeasurementsElectronic Health Records provided cancer screening data (primary outcome). PHQ-9 measured depression at study entry (T0), 6- and 12-months post-baseline (T1 and T2, respectively; secondary outcome). ResultsAnalyses revealed statistically significant increases in up-to-date status for all cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the two interventions in improving cancer screening rates or reducing depression. LimitationsDepressive symptom improvement may be explained by typical symptom remission. The study duration (12-months) was insufficient to evaluate intervention effects on long-term cancer screening behavior and depression. This study was not powered for site-level analysis. ConclusionsCCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities, however neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources. Funding sourceThis study was funded by Patient Centered Outcomes Research Institute (PCORI) (IH-12-11-4522) with additional infrastructure support from Agency for Healthcare Research and Quality (AHRQ) (5P30-HS-021667).