| Objective: To evaluate cost-effectiveness of a stepped care strategy to improve symptoms of depression or anxiety in lung (LC) and head and neck (HNC) cancer patients. Research question: In the Netherlands over 10.000 patients are diagnosed with LC or head HNC every year and treated with curative intent of whom 25-50% have anxiety or depression as comorbid condition. Is a stepped care strategy applied in an oncological setting more (cost-)effective to improve symptoms of anxiety and depression compared with care as usual? Study design: Randomised controlled trial. Follow up at 3, 6, 9 and 12 months. Study population: LC and HNC patients with DSM-IV diagnoses of depression (minor or major) or a generalized anxiety disorder as measured with the Composite International Diagnostic Interview (CIDI) after curative treatment. Intervention is a stepped care model with 4 steps: 1. Watchful waiting, 2. Internet-based self-help, 3. Problem Solving Therapy applied by a nurse, and 4. Specialised psychological interventions and/or antidepressant medication. Control group patients will receive care as usual which most often is no intervention or referral to specialised intervention. Primary outcome is the Hospital Anxiety and Depression Scale (HADS). Secondary outcome measures are quality of life questionnaires (EORTC QLQ-C30, EORTC QLQ-HN35, EORTC QLQ-LC13), patient satisfaction with care (EORTC QLQ-PATSAT), and costs (health care utilization and work loss). |
