• Aggregate number of targeted problems [ Designated as safety issue: No ]
  

• Mean z score combining the Vitality and Physical Function subscales of the SF-36 [ Designated as safety issue: No ]
  
• Mean z score combining the Symptom Checklist 90-R Depression scale and the Cancer and Treatment Distress-Uncertainty subscale [ Designated as safety issue: No ]
  
• Total health-care utilization behaviors [ Designated as safety issue: No ]
  

OBJECTIVES:

• To compare the efficacy of an Internet-only intervention vs an Internet intervention with phone-based problem-solving and activation training vs delayed access to Internet intervention in improving fatigue/physical dysfunction, depression/distress, and health surveillance behaviors in long-term survivors of hematopoietic stem cell transplantation.

OUTLINE: Patients are stratified according to gender, type of stem cell transplantation (autologous vs allogeneic), ethnicity (non-Caucasian or Hispanic vs Caucasian or non-Hispanic), and transplant location (Fred Hutchinson Center vs non-Fred Hutchinson center). Patients with elevated fatigue, depression, and/or distress on baseline assessment are randomized to 1 of 3 arms. Patients without elevated fatigue, depression, and/or distress on baseline assessment are randomized to 1 of 2 arms (arms II or III).

• Arm I (full website access with problem-solving training [PST]): Patients receive full access to INSPIRE website for 6 months, which offers an individually tailored greeting home page with links to information on each of the target areas identified as being elevated on baseline assessment and how to manage the complications; a bulletin board with input from other survivors that is solicited, edited, and posted weekly; resource pages; and an opportunity to send secure messages with questions or comments. Patients also undergo 4-8 phone-based PST sessions with a behavioral health specialist.
• Arm II (full website access without PST): Patients receive full access to INSPIRE website for 6 months as in arm I.
• Arm III (delayed website access): Patients do not have access to INSPIRE website for 6 months. After 6 months, patients receive full access to INSPIRE website for 3 months. Patients complete online questionnaires at baseline and at 3 and 6 months to assess fatigue, physical activity, depression, and distress.