One‐Year Effect of a Nurse‐Led Psychosocial Intervention on Depressive Symptoms in Patients With Head and Neck Cancer: A Randomized Controlled Trial

Background. Many patients with head and neck cancer (HNC) experience depressive symptoms after treatment. This randomized controlled trial investigated the effects of a psychosocial nurse counseling and after intervention (NUCAI) versus usual care on the depressive and HNC‐related physical symptoms of patients with HNC at 1 year after diagnosis. Methods. A total of 205 patients with HNC were randomly assigned to either intervention (n = 103) or usual care (n = 102), with stratification for gender and tumor stage. The NUCAI, which consisted of six bimonthly 45‐minute counseling sessions, was a problem‐focused intervention aimed at helping patients to manage the physical, psychological, and social consequences of HNC and its treatment. It was nurse‐led and offered in combination with regular medical follow‐up visits at the University Medical Center Utrecht, the Netherlands. Depressive symptoms at 1 year after diagnosis were the primary outcome. Analyses were performed on an intention‐to‐treat basis for the total sample and for a predefined subgroup of patients with raised levels of depressive symptoms (Center for Epidemiologic Studies–Depression score ≥12; n = 91) at baseline using mixed‐effect models. Results. One year after HNC treatment, levels of depressive symptoms were significantly lower in the intervention group than in the control group in the total sample and in the subgroup of patients with raised levels of depressive symptoms. Conclusion. The NUCAI was feasible and effective in reducing depressive symptoms in patients with HNC 1 year after HNC treatment, and especially in patients with raised levels of depressive symptoms. The results of this study need to be confirmed in future studies before the NUCAI can be used in daily clinical practice. 摘要 背景. 众多头颈部癌症（HNC）患者治疗后出现抑郁症状。本项随机对照试验调查心理社会护士咨询和事后干预（NUCAI）对比常规治疗对HNC患者诊断1年后抑郁和HNC相关躯体症状的效应。 方法. 共 205 例HNC患者随机接受干预（n = 103）或常规治疗（n =102），按性别和肿瘤分期进行分层。NUCAI由6次咨询组成，每2个月一次，每次45分钟，属于以问题为重点的干预，旨在帮助患者处置与HNC及其治疗相关的躯体、心理和社会学问题。该干预由护士主导，与常规医疗随访联合进行，地点在荷兰乌特勒支大学医疗中心。主要转归指标是疾病诊断后1年时的抑郁症状。采用混合效应模型，按意向性治疗对总体样本和基线时抑郁症状水平升高（流行病学研究中心抑郁评分³ 12；n = 91）的预设患者亚组进行分析。 结果. HNC治疗1年后，在总体样本和抑郁症状水平升高患者亚组中，与对照组相比，干预组的抑郁症状水平明显降低。 结论. NUCAI具有可行性，能够有效减轻HNC患者接受治疗1年后的抑郁症状，尤其在抑郁症状水平升高的患者中更是如此。在NUCAI能够应用于日常临床实践之前，本研究结果尚有待未来研究的进一步证实。 This randomized controlled trial investigated the effects of a psychosocial nurse‐led intervention on the depressive and cancer‐related physical symptoms of patients with head and neck cancer. The intervention w