Adaptive, Stepped-Care for Cancer-Related PTSD Symptoms in HCT Survivors: Results From a SMART Trial.

IF 3.9 2区医学 Q2 ONCOLOGY

Psycho‐Oncology Pub Date : 2026-08-01 DOI:10.1002/pon.70554

Sophia K Smith, Eric Kuhn, Tamara J Somers, Eric Laber, Cole Manschot, Anthony D Sung, Sarah A Kelleher, Catherine Majestic, Karen L Syrjala, Deborah Mayer, Sergio Giralt, Andrea Pires, Rebecca R Gebert, Jason E Owen, Jean C Yi, Allison J Applebaum

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引用次数: 0

Abstract

Objective: Cancer-related posttraumatic stress disorder (PTSD) is prevalent among hematopoietic cell transplantation (HCT) survivors, yet access to evidence-based care is limited. This study evaluated adaptive, stepped-care treatment sequences for PTSD symptoms using a Sequential Multiple Assignment Randomized Trial (SMART), comparing digital and therapist-delivered interventions.

Methods: HCT survivors (N = 477), 1-5 years post-transplant, with probable or subthreshold PTSD, were randomized to the Cancer Distress Coach (CaDC) app or Usual Care. At Week 4, non-responders (i.e., < 5-point PCL-5 reduction) were re-randomized to CaDC + Coaching or therapist-delivered cognitive behavioral therapy for PTSD (CBT-PTSD). PTSD symptoms (primary outcome), depression, and anxiety were assessed at baseline, Week 4, Month 3 (primary endpoint), and Month 6.

Results: Both initial treatment groups demonstrated symptom reductions at Week 4 with no significant between-group differences; approximately 60% met early response criteria. By Month 3, outcomes reflected treatment escalation rather than direct comparison of initial interventions. Regimen-level analyses demonstrated differences across adaptive sequences for PTSD at Months 3 and 6, and for depression and anxiety at Month 3 (global p-values ≤ 0.018). Regimens escalating to CBT-PTSD were associated with greater and more sustained reductions than those escalating to CaDC + Coaching. The sequence initiating with CaDC and escalating to CBT-PTSD produced the largest effects.

Conclusions: Although a self-guided digital intervention did not outperform Usual Care initially, adaptive stepped-care strategies that triage early responders and escalate non-responders to therapist-delivered CBT-PTSD were associated with the greatest reductions in symptoms. Digital tools may function as entry points within stepped-care models to allocate higher-intensity psychotherapy.

Trials registration: ClinicalTrials.gov, NCT04058795, registered 8/16/2019.

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HCT幸存者癌症相关PTSD症状的适应性、阶梯式护理：来自SMART试验的结果

目的：癌症相关创伤后应激障碍（PTSD）在造血细胞移植（HCT）幸存者中普遍存在，但获得循证治疗的机会有限。本研究使用顺序多任务随机试验（SMART）评估了PTSD症状的适应性、阶梯式治疗序列，比较了数字化和治疗师提供的干预措施。方法：移植后1-5年的HCT幸存者（N = 477），可能患有或阈下创伤后应激障碍，随机分配到癌症困扰教练（CaDC）应用程序或常规护理。在第4周，无反应（即PCL-5降低< 5点）被重新随机分配到CaDC +辅导或治疗师提供的PTSD认知行为治疗（CBT-PTSD）。在基线、第4周、第3个月（主要终点）和第6个月评估PTSD症状（主要结局）、抑郁和焦虑。结果：两个初始治疗组在第4周均表现出症状减轻，组间无显著差异；约60%达到早期反应标准。到第3个月，结果反映了治疗的升级，而不是直接比较初始干预措施。方案水平分析显示，在第3个月和第6个月，在第3个月，在抑郁和焦虑方面，适应序列之间存在差异（总体p值≤0.018）。升级为CBT-PTSD的治疗方案与升级为CaDC +辅导的治疗方案相比，有更大、更持久的减少。从CaDC开始到升级为CBT-PTSD的顺序产生了最大的影响。结论：尽管自我引导的数字干预最初并没有优于常规护理，但适应性的分步护理策略（对早期反应者进行分类，并将无反应者升级为治疗师提供的CBT-PTSD）与症状的最大减少有关。数字工具可以作为分步治疗模式的切入点来分配高强度的心理治疗。试验注册：ClinicalTrials.gov, NCT04058795，注册日期为2019年8月16日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psycho‐Oncology 医学-心理学

CiteScore

6.30

自引率

8.30%

发文量

220

审稿时长

3-8 weeks

期刊介绍： Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues. Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.