Abstract
PURPOSE: Three sequences of telephone symptom management interventions were tested on use of unscheduled health services among cancer survivors with depressive or anxiety symptoms during treatment (N = 334) and their informal caregivers (N = 333). METHODS: The three 12-week intervention sequences were as follows: (1) Symptom Management and Survivorship Handbook (SMSH), (2) a combined 8-week SMSH + Telephone Interpersonal Counseling (TIPC) followed by SMSH for 4 weeks, and (3) SMSH for 4 weeks followed by a combined SMSH + TIPC if no response to SMSH alone. Survivor-caregiver dyads were first randomized to SMSH or a combined SMSH + TIPC. If the survivor's depressive or anxiety symptoms persisted after 4 weeks of SMSH alone, the dyad was randomized the second time to continue with SMSH alone or TIPC was added to SMSH. All participants were assessed at baseline and 13 and 17 weeks. Health service use was compared between randomized groups and among the three sequences. RESULTS: Survivors were 60.2 years of age, 79% were female, and 41% were Hispanic. Caregivers were 54.8 years of age; 67% were female. The significantly lower rate of emergency department (ED) or urgent care visits for survivors was found in the SMSH + TIPC intervention sequence compared to the SMSH alone in the second randomization and for the third intervention sequence compared to the first. CONCLUSIONS: Adding TIPC to SMSH after week 4 when survivors experienced persisting depressive or anxiety symptoms reduced ED/urgent care visits compared to SMSH alone. IMPLICATIONS FOR CANCER SURVIVORS: Managing depression and anxiety symptoms may help prevent ED/urgent care visits and worsening of other symptoms.