Stepped-Care Telehealth for Distress in Rural Cancer Survivors

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)28,29
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.

- Residency in a rural zip code defined as below by the Rural-Urban Commuting Areas
(RUCA) Version 3.1. Residential zip codes are assigned an RUCA code based on size of
its largest population center and commuting patterns. Urban: 1.0, 1.1, 2.0, 2.1, 3.0,
4.1, 5.1, 7.1, 8.1, and 10.1 Rural: 4.0, 4.2, 5.0, 5.2, 6.0, 6.1, 7.0, 7.2, 7.3, 7.4,
8.0, 8.2, 8.3, 8.4, 9.0, 9.1, 9.2, 10.0, 10.2, 10.3, 10.4, 10.5, and 10.6

- 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].

- 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.

- Global cognitive impairment based on education-adjusted scores on the Telephone
Interview for Cognitive Status-modified

- Self -reported psychotic symptoms in the last 30 days

- 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 )