Results Summary

What was the research about?

Due to problems like difficulty breathing, eating, or swallowing, patients with lung or head and neck cancer and their caregivers often have anxiety, depression, or trouble coping. People with low incomes or with little or no health insurance may not be able to get needed mental health care.

In this study, the research team tested a stepped-care program for treating emotional distress in patients and their caregivers. In stepped care, people received services based on their level of distress, or step. They could also receive care at a higher step if needed. The steps were:

  • Step 1: People with no symptoms of distress had one orientation session and monitoring for new symptoms. They didn’t receive treatment.
  • Step 2: People with mild symptoms had the care in step 1 plus one session with a counselor to review a self-help guide about coping and managing stress.
  • Step 3: People with moderate symptoms had the care in steps 1 and 2 plus two training sessions with a counselor to learn about ways to cope.
  • Step 4: People with severe symptoms had the care in steps 1–3 plus four sessions with a counselor to help change responses to emotional distress.

The research team compared stepped care plus usual care versus usual care alone.

What were the results?

After six months, compared with usual care alone, patients in stepped care had:

  • Improvements in depression, anxiety, and quality of life, but not enough to be meaningful for patients
  • Better coping skills
  • Similar levels of stress

Compared with usual care alone, caregivers in stepped care had:

  • Similar levels of depression, anxiety, and coping skills
  • Less stress and caregiver burden

Who was in the study?

The study included 286 patients with lung or head and neck cancer receiving care at one of four hospitals in Colorado, and 249 caregivers. All had low incomes or little or no health insurance. Among patients, 86 percent were White, 5 percent were Black, 6 percent didn’t report a race, and 4 percent selected other; 21 percent were Hispanic. The average age was 66, and 58 percent were men.

What did the research team do?

The research team assigned patients and caregivers by chance to receive stepped care plus usual care or usual care alone. In usual care, patients received a list of mental health resources, providers, and support groups. Patients and caregivers could take part in the study together or separately.

Patients and caregivers completed surveys at the start of the study and six months later.

Cancer survivors, caregivers, and clinicians gave input throughout the study.

What were the limits of the study?

This study took place in one state; most people in the study were White. Results may differ in other places or for people of other racial backgrounds.

Future research could see if more intense treatment would reduce distress.

How can people use the results?

Hospitals can use these results when considering ways to provide mental health care for patients with cancer and their caregivers.

Final Research Report

View this project's final research report.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Evelinn A. Borrayo, PhD
University of Colorado Denver
A Stepped-Care Intervention to Reduce Disparities in Mental Health Services among Underserved Lung and Head and Neck Cancer Patients and their Caregivers

Key Dates

July 2016
March 2023

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 14, 2024