Pain and depression are common but often unaddressed in patients with cancer. Kroenke and colleagues studied 405 patients from 16 urban and rural Indiana oncology practices who were identified as having at least moderately severe depression or moderately severe cancer-related pain unresponsive to at least one pain medication, or both.

Patients were randomized to either a standard care group (they were told of their symptoms and their oncologist received screening results) or an intervention group (they received telephone calls from a nurse care manager at baseline, weeks one, four, and 12, and when an automated monitoring system indicated inadequate symptom improvement, an adverse event, or a suicidal ideation, for example). Patients chose their mode of automated contact: a Web-based survey or an interactive telephone recording twice weekly for the first three weeks, decreasing steadily to once a month during the last six months of the 12-month study.

Both pain severity and depression significantly improved in the intervention group compared with the standard care group during the trial. The authors point out, however, that the study is limited by the inclusion of all types and phases of cancer, the lack of electronic medical records at some practices, and no economic analyses.