Caregivers, typically family members or friends, provide more than half of the care needed for cancer survivors, often with negative health consequences. At least 30% of survivors and their caregivers report psychological distress (depression and anxiety) and such distress may interfere with optimal symptom management. This study will support both members of the survivor-caregiver dyad in the management of the survivor’s cancer- and treatment-related symptoms and the dyad’s psychological distress. There are no such studies reported from India on the integration of two potentially synergistic interventions, SMT, and TIP-C to achieve outcomes that are better than a simple sum of the two because, as argued under the scientific premise. SMART design will be used for this study over alternative designs (e.g., implementation designs) because the SMART design allows a precision or personalized approach to determine the right treatment at the right dose with the right sequence for the right survivor-caregiver dyad. The objectives of this study are to determine if dyads in the TIP- C+SMT as compared to the SMT alone will have lower depression, anxiety, and summed severity of 13 other symptoms, lower use of healthcare services (hospitalizations, and emergency care), greater self-efficacy, social support, and lower caregiver burden. It will also test the interdependence in survivor’s and caregiver’s primary and secondary outcomes.

We will use two evidence-based interventions: Symptom Management Toolkit (SMT) and Telephone Interpersonal Counseling (TIP-C). Although we have established the overall efficacy of these interventions, individuals differ in responses. We will enroll 298 survivors with elevated depression or anxiety who are undergoing radiotherapy, chemotherapy, or targeted therapy for a solid tumor and their 298 caregivers. Dyads will be initially randomized to SMT alone or TIP-C +SMT. Outcome data will be collected at baseline, weeks 13 (post-intervention) and 17 (follow-up). Assessments during weeks 1-12 will document changes in symptoms, intervention receipt, enactment, and fidelity. Caregivers’ and survivors’ symptoms will be measured using the adapted General Symptom Distress Scale (GSDS). Caregivers’ and survivors’ depression and anxiety, self-efficacy, and social support will be measured by PROMIS-short forms 8. Findings will be used to improve symptom management and reduce distress in survivor-caregiver dyads.