Novel, Stepped Collaborative Care Improves Symptom Management and QOL During Cancer Treatment

July 10, 2024 by Elisa Becze BA, ELS, Editor

An integrated screening and stepped collaborative care strategy produced a greater improvement in patients’ quality of life (QOL) and management of depression, pain, and fatigue during the first six months of cancer treatment, researchers reported in study findings ( published in The Lancet. Patients maintained the benefits at 12 months, as well.

For the randomized, parallel, phase III trial, researchers assigned patients aged 21 or older from 29 oncology outpatient clinics who had any cancer type and clinical levels of depression, pain, or fatigue to receive the intervention or standard care. Both approaches began with symptom screening and referrals for management, but the intervention was integrated as part of the patients’ routine cancer care. For the stepped collaborative care, patients participated in once-weekly, 50- to 60-minute telehealth-based cognitive behavioral therapy. The continued monitoring enabled providers to step up the therapy’s frequency, add or transition to pharmacotherapy if warranted or preferred by the patient, or otherwise tailor the intervention to patients’ individual needs. For standard of care, patients were simply screened and referred to appropriate providers specific symptoms. 

From December 5, 2016–April 8, 2021, researchers enrolled 222 patients in standard of care and 237 in stepped collaborative care. During the study period, about 75% of the patients in the intervention group who were offered support began treatment with a trained counselor, compared with only about 4% of the patients in the standard care group. At six months’ follow-up, patients in the intervention group had a greater improvement in health-related QOL than those in standard care. Patients in the intervention group also had greater improvements in emotional, functional, and physical well-being and had fewer emergency department visits, fewer hospital readmissions within 90 days, and shorter hospital stays than those in the standard care group. The benefits were sustained at 12 months’ follow-up, and neither group experienced any adverse events related to the study.

A major limitation of the findings is that the study population lacked diversity and was more than 90% White. Additional research with participants who more accurately represent the patient population is needed to confirm feasibility and applicability in real-world clinical practice. The current study’s researchers are planning a clinical trial to evaluate the new approach in nearly 100 clinics at their cancer center.

“An integrated screening and novel stepped collaborative care intervention, compared with the current standard of care, is recommended to improve health-related QOL,” the researchers concluded ( “The findings of this study will advance the implementation of guideline-concordant care (screening and treatment) and have the potential to shift the practice of screening and treatment paradigm nationwide, improving outcomes for patients diagnosed with cancer.”

Oncology nurses can find evidence-based interventions for the most common cancer-related symptoms in the ONS Guidelines and Symptom Interventions (

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