Findings:
ConquerFear is a therapeutic intervention for reducing the fear of cancer recurrence in cancer survivors, and this study it was compared to an active relaxation training program called “Taking-it-Easy” (TIE), both delivered by a trained therapist. The characteristics, completion rate and costs in between groups were comparable; however, ConquerFear outperformed TIE in the assessment of the quality of life, and also saves costs as measured on Quality-adjusted life year with average incremental health gain of 0.0142 QALYs. Overall this intervention proved that at a modest cost provides excellent value and return on investment.

Strengths and limitations:
This is a study based on data obtained from a previous randomized control study. The cost-effectiveness and cost-utility analysis conducted allowed for adequate analysis of the available data; however, several limitations exist. First, the original study did not allow for a care-as-usual control group, which limited the observation of the impact at a broader scale. Another limitation is that there was a substantial number of subjects who did not return all the data which limits the interpretation of the results; however, a buffer may be that fact that those subjects were less engaged in the intervention, were also less likely to submit the study self-report data. Finally, the analysis did not capture the impact on families in therm s QALY gains.

Relevance:
Fear of cancer recurrence affects both cancer survivors and their families. Patients with high fear of recurrence are less satisfied with the care, more likely to refuse discharge from cancer care and to be readmitted into care. This is the first study to examine and address the cost-effectiveness of an intervention geared towards long term psychological wellness of these subgroup of cancer survivors and presents an alternative framework to analyze results of an intervention, beyond the traditional outcome measurements.

Type of study:
cost-effective and cost utility analysis of two interventions, following a randomized controlled trial

Findings:
This is a systematic review of the literature that aimed to describe the existing evidence in regards of caregiver access to community-based cancer helplines, their satisfaction with the service and the efficacy of these lines in improving psychosocial outcomes for caregivers. The first finding is that less than half of caregivers access these lines, (14-47%), much lower than rates reported for cancer patients (up to 66%). The reasons for calling were information on cancer treatment, symptoms management, and emotional support. Interestingly, the findings suggest that the need for emotional support, while present, was not the motive of calling and that operators often needed to use probes to detect underlying psychological needs, which were highly prevalent. The second finding reported that the levels of satisfaction with the quality of the services and the skills of the operators were excellent, and the overall acceptability was high. Unfortunately, the third finding documented that those studies with strong methodological rigor provided limited evidence that the helpline services actually changed the measured outcomes. Studies with no control arms had more favorable results, yet the authors conclude that it is possible that the changes seen were not entirely generated by the intervention. The authors conclude that more scientific evidence is needed to draw conclusions about the real impact of these lines.

Strengths and limitations:
The systematic review included a group of 45 studies compromised of both randomized controlled trials and single-arm trials. The randomized studies’ rigor and heterogenicity allow the application of these findings to a broader population. However, the quality of the overall existing evidence is mostly descriptive, making it challenging to draw realistic conclusions.

Relevance:
Supportive interventions are hard to examine; they carry hidden costs, are challenging to implement and scale, and the actual benefits are hard to estimate accurately. This is the first study aimed at examining the feasibility, accessibility, satisfaction, and efficacy of an intervention geared towards supporting caregivers of cancer patients. It highlights how little we truly understand these interventions and the need for a more rigorous examination of these modalities of care delivery.

Type of study:
Systematic Review

Findings:
This study used Baysian network meta-analysis to determine the comparative efficacy of various analgesic classes and individual analgesics at controlling chronic cancer pain. The study found that among analgesic classes, the most effective at controlling pain were the non-opioid analgesics (e.g., acetaminophen, dextromethorphan, ketamine, lidocaine, among others), non-steroidal anti-inflammatories, and the opioids. Among the individual analgesic medications, the most effective at controlling chronic cancer pain were lidocaine, codeine plus aspirin, and pregabalin.

Strengths and limitations:
The major strength of this study is that the authors compared a variety of different classes of analgesics, in contrast to most previous studies which have tended to only compare opiates. Limitations of the study include significant heterogeneity found between some studies, as well as publication bias which may have overestimated the findings.

Relevance to Consultation-Liaison Psychiatrists:
Psycho-oncology providers are often called upon to assess and treat patients with cancer pain. Given that studies continue to report undertreatment of cancer pain, it is prudent for CL psychiatrists working in the cancer setting to be aware of evidence-based cancer treatments. The authors reported that in contrast to commonly held beliefs about the superiority of opiates, several non-opioid medications appear to be as effective as opiates in treating chronic cancer pain, including NSAIDs, lidocaine, and pregabalin.

Type of study:
Meta-analysis