Purpose:
Mental health issues in post-treatment adult cancer survivors are associated with multiple
adverse outcomes and may represent a cancer health disparity for rural survivors. The purpose
of this study is to test a stepped-care approach tailored to symptom severity based on recent
American Society of Clinical Oncology guidelines for reducing emotional distress (anxiety
and/or depressive symptoms) and improving secondary outcomes (sleep disturbance, fatigue,
fear of recurrence, quality of life) in rural, post-treatment cancer survivors in community
oncology settings and to examine intervention costs. The resultant intervention will have
great potential for widespread dissemination since it will be manualized, delivered by
telephone, and comprised of modules to allow customized treatments for individuals with
different cancer types.
Criteria:
Inclusion Criteria:
- Age ≥18 years
- Score ≥10 on the GAD-7 and/or a score ≥8 on the PHQ-9, indicating clinically
significant anxiety or depressive symptoms, respectively.
- Past history of treated Stage I, II, or III (newly diagnosed or recurrent) breast,
colorectal, prostate, gynecologic (to include uterine and cervical) cancers and
non-Hodgkin's lymphoma.
- 6-60 months post-treatment (surgery, chemotherapy, and/or radiation therapy) for
cancer. Time frame applies to most recent completion of treatment if participant had a
cancer recurrence. It is acceptable to be on maintenance or hormonal therapies.
- Participant resides in California, Georgia, Illinois, Kansas, Michigan, Minnesota,
Missouri, New Mexico, North Carolina, North Dakota, South Carolina, Virginia,
Tennessee, or Wisconsin
- Study-trained therapist in the state where the participant resides.
- Must be able to speak and understand English.
- Must have access to a telephone
Exclusion Criteria:
- Current psychotherapy [regular appointment(s) with a psychologist, counselor, or
therapist within the last 30 days prior to randomization].
- Self-reported active alcohol or substance abuse within the last 30 days.
- Past history of prostate cancer or non-Hodgkin's lymphoma with only active
surveillance (i.e., no surgery, chemotherapy, or radiation therapy).
- Diagnosis of a second malignancy (except for non-melanoma skin cancers) after a
previous diagnosis of breast, colorectal, gynecologic cancers and non-Hodgkin's
lymphoma
- Progressive cancer (must be considered no evidence of disease or stable)
- Self -reported history of a diagnosis of dementia from a healthcare provider.
- Self -reported psychotic symptoms in the last 30 days prior to randomization
- Active suicidal ideation (currently reported suicidal plan and intent).
- Any change in psychotropic medications within the last 30 days.
- Hearing loss that would preclude participating in telephone sessions (determined by
brief hearing assessment administered by research staff)
- Failure/inability/unwillingness to provide names and contact information for two
family members or friends to serve as emergency contacts during the course of the
study.