Problem-Solving Therapy Improves Cancer Caregiver Mental Health: Results from a Randomized Controlled Trial

Background and Purpose: Shifts toward the outpatient clinic as the primary setting for cancer treatment have culminated in 4.6 million family caregivers supplying the majority of the routine care that has historically been provided on a hospital inpatient basis. Doing so comes at substantial burden to caregivers, since recognized as the “invisible backbone” of cancer care. Documented outcomes thereof include anxiety, depression, and—in severe instances—psychological symptoms commensurate with those of trauma. Skill-building interventions, such as our pilot work with problem-solving therapy (PST), have been particularly beneficial in combatting such outcomes. The objective of the current study was to evaluate the efficacy of the PISCES (Problem-solving Intervention to Support Caregivers in Everyday Situations) intervention in reducing symptoms of self-reported depression and anxiety and improving self-reported positive aspects of caregiving in cancer caregivers (Project No. R01CA258311).

Methods: For this randomized controlled trial, we recruited cancer caregivers across four geographically diverse outpatient palliative care clinics from January 2022 through October 2025. Recruitment occurred via electronic medical record dashboard report. The randomized sample with completed baseline surveys (N = 460) was mostly White (n = 350, 77.1%), female (n = 316, 69.0%), and identified as spouse/partner of the patient (n = 249, 54.1%), with an average age of 55.1 years (SD = 15.2). Participants were randomized 1:1 into either intervention (n = 228) or attention control (n = 232) arms. Based on a dominant 5-step model of PST, the intervention arm received three 1-hour-long structured PST sessions delivered by a trained interventionist in a weekly 1:1 virtual format. Participants completed self-administered electronic surveys at baseline; postintervention; and 30-day postintervention follow-up. We analyzed effects of intervention arm assignment from baseline to each subsequent data collection time point on participant-reported symptoms of depression and anxiety and participant-reported positive aspects of caregiving via separate constrained longitudinal analysis models adjusted for time nested in person.

Results: Results indicated that, compared to the attention control arm, the intervention arm showed significantly greater reductions in symptoms of anxiety (postintervention: B = −1.83, p = .008; 30-day postintervention follow-up: B = −1.61, p = .022) and depression (postintervention: −2.00, p = .002; 30-day postintervention follow-up: B = −1.36, p = .038). Positive aspects of caregiving were significantly greater in the intervention group at 30-day postintervention follow-up (B = −1.04, p = .015).

Conclusions and Implications: These results show that PISCES is efficacious in improving key psychosocial outcomes affecting cancer caregivers’ ability to meaningfully engage in the provision of care. Favorable decreases in anxiety and depression observed both proximately and distally contrasted with favorable increases in positive aspects of caregiving observed only distally. It may be that first attenuating the negative cognitive bias brought on by these symptoms facilitates more holistic self-appraisal that allows caregivers to derive more benefit. These results provide a formative next step toward effectiveness trials needed to inform adoption into routine practice.