Stepped care is effective and reduces recovery time among patients with head and neck cancer or lung cancer and untreated psychological distress, according to findings published in the journal Annals of Oncology.1

For the study, researchers enrolled 156 patients with lung or head and neck cancer and untreated distress (Hospital Anxiety and Depression Scale [HADS; HADS-D >7, HADS-A >7, or HADS-total >14]). Participants were randomly assigned 1:1 to receive stepped care or usual care.

Stepped care consisted of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy and/or psychotropic medication. Psychological distress was assessed at baseline, after completion of care, and at 3, 6, 9, and 12 months of follow-up.

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Results showed that the course of psychological distress was better after stepped care compared with usual care (HADS-total, P = .005; HADS-A, P = .046; HADS-D, P = .007). Furthermore, patients in the stepped care group had less anxiety and depression posttreatment and at 9 months of follow-up than those receiving usual care.

Researchers found that recovery rate posttreatment was 55% after stepped care targeting psychological distress compared with 29% after usual care (P = .002), and 46% vs 37% at 12 months, respectively (P = .35).

Within the stepped care group, 28% of patients recovered after watchful waiting, 34% after guided self-help, 9% after problem-solving therapy, and 17% after psychotherapy and/or psychotropic medication.

The study also demonstrated that patients with a depressive or anxiety disorder had an even greater benefit from stepped care vs those without such a disorder (P = .001).


1. Krebber AM, Jansen F, Witte BI, et al. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized controlled trial [published online June 10, 2016]. Ann Oncol. doi:10.1093/annonc/mdw230.