{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:05:05Z","timestamp":1789571105947,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01\u2010CA244172"],"award-info":[{"award-number":["R01\u2010CA244172"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cancer\u2010related posttraumatic stress disorder (PTSD) is prevalent among hematopoietic cell transplantation (HCT) survivors, yet access to evidence\u2010based care is limited. This study evaluated adaptive, stepped\u2010care treatment sequences for PTSD symptoms using a Sequential Multiple Assignment Randomized Trial (SMART), comparing digital and therapist\u2010delivered interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      HCT survivors (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0477), 1\u20135\u00a0years post\u2010transplant, with probable or subthreshold PTSD, were randomized to the Cancer Distress Coach (CaDC) app or Usual Care. At Week 4, non\u2010responders (i.e., &lt; 5\u2010point PCL\u20105 reduction) were re\u2010randomized to CaDC\u00a0+\u00a0Coaching or therapist\u2010delivered cognitive behavioral therapy for PTSD (CBT\u2010PTSD). PTSD symptoms (primary outcome), depression, and anxiety were assessed at baseline, Week 4, Month 3 (primary endpoint), and Month 6.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both initial treatment groups demonstrated symptom reductions at Week 4 with no significant between\u2010group differences; approximately 60% met early response criteria. By Month 3, outcomes reflected treatment escalation rather than direct comparison of initial interventions. Regimen\u2010level analyses demonstrated differences across adaptive sequences for PTSD at Months 3 and 6, and for depression and anxiety at Month 3 (global\n                      <jats:italic>p<\/jats:italic>\n                      \u2010values \u2264 0.018). Regimens escalating to CBT\u2010PTSD were associated with greater and more sustained reductions than those escalating to CaDC\u00a0+\u00a0Coaching. The sequence initiating with CaDC and escalating to CBT\u2010PTSD produced the largest effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although a self\u2010guided digital intervention did not outperform Usual Care initially, adaptive stepped\u2010care strategies that triage early responders and escalate non\u2010responders to therapist\u2010delivered CBT\u2010PTSD were associated with the greatest reductions in symptoms. Digital tools may function as entry points within stepped\u2010care models to allocate higher\u2010intensity psychotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trials registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      , NCT04058795, registered 8\/16\/2019\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70554","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:57:14Z","timestamp":1786103834000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adaptive, Stepped\u2010Care for Cancer\u2010Related PTSD Symptoms in HCT Survivors: Results From a SMART Trial"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7809-0339","authenticated-orcid":false,"given":"Sophia K.","family":"Smith","sequence":"first","affiliation":[{"name":"School of Nursing Duke University  Durham North Carolina USA"},{"name":"Duke Cancer Institute Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Dissemination and Training Division National Center for PTSD  Palo Alto California USA"},{"name":"Department of Psychiatry and Behavioral Sciences School of Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara J.","family":"Somers","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Duke University Medical Center  Durham North Carolina USA"},{"name":"Department of Psychiatry and Behavioral Sciences Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2640-7696","authenticated-orcid":false,"given":"Eric","family":"Laber","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5054-2663","authenticated-orcid":false,"given":"Cole","family":"Manschot","sequence":"additional","affiliation":[{"name":"Biostatistics and Research Decision Sciences (BARDS) Merck &amp; Co., Inc.  Rahway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony D.","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Kelleher","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Duke University Medical Center  Durham North Carolina USA"},{"name":"Department of Psychiatry and Behavioral Sciences Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5661-1853","authenticated-orcid":false,"given":"Catherine","family":"Majestic","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Duke University Medical Center  Durham North Carolina USA"},{"name":"Department of Psychiatry and Behavioral Sciences Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Syrjala","sequence":"additional","affiliation":[{"name":"Clinical Research Division Fred Hutchinson Cancer Research Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Mayer","sequence":"additional","affiliation":[{"name":"School of Nursing University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Giralt","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Pires","sequence":"additional","affiliation":[{"name":"School of Nursing Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7069-5405","authenticated-orcid":false,"given":"Rebecca R.","family":"Gebert","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences Boston University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason E.","family":"Owen","sequence":"additional","affiliation":[{"name":"Dissemination and Training Division National Center for PTSD  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4589-7272","authenticated-orcid":false,"given":"Jean C.","family":"Yi","sequence":"additional","affiliation":[{"name":"Clinical Research Division Fred Hutchinson Cancer Research Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2140-5635","authenticated-orcid":false,"given":"Allison J.","family":"Applebaum","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215\u20100366(17)30014\u20107"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3654"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjb.2023.42"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29818"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2020.38.15_suppl.7505"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010025\u201006599\u20105"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12082756"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.73.2800"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22987"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.6213"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5964"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.26.8722"},{"key":"e_1_2_10_14_1","unstructured":"Cancer\u2010Related Post\u2010traumatic Stress (PDQ\u00ae)\u2014NCI. 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