Stepped care to improve depression and anxiety in cancer patients.

In the Netherlands over 10.000 patients are diagnosed with lung cancer (LC) or head and neck cancer (HNC) every year of whom 25-50% have comorbid anxiety or depression after treatment. Although there is evidence on efficacy of psychosocial cancer care in general, patients with poor survival rates (LC) or less prevalent tumours (HNC) are often not involved, while these patients are among the most distressed patients. Barriers to admission to psychosocial care are a lack of adequate screening instruments in oncology settings, and that traditional models of the delivery of psychosocial care do not meet current demands. A stepped care approach including a web-based self-help intervention has the potential to improve the efficiency of psychosocial care.
Objective of this study is to evaluate cost-effectiveness of a stepped care strategy to improve symptoms of depression or anxiety in patients treated for head and neck cancer or lung cancer.

In the Netherlands over 10.000 patients are diagnosed with head and neck cancer or lung cancer every year of whom 25-50% have comorbid anxiety or depression.
Is a stepped care strategy applied in an oncological setting more (cost-)effective to improve symptoms of anxiety and depression compared with care as usual?

0, 3, 6, 9 en 12 months.

Stepped care model with 4 evidence based steps:

1. Watchful waiting;

2. Internet-based self-help;

3. Problem Solving Therapy applied by a nurse;

4. Specialised psychological interventions and/or antidepressant medication.


Control group patients receive care as usual.