Informal caregivers typically family members or friends provide more than half of the care needed for the 5.7million cancer survivors in the United States often with negative health consequences. At least 30% ofsurvivors and their caregivers report psychological distress (depression and anxiety) and such distress mayinterfere with optimal symptom management. This study will support both members of the survivor-caregiverdyad in the management of the survivor's cancer- and treatment-related symptoms and the dyad'spsychological distress. Design: We will use the sequential multiple assignment randomized trial (SMART)design a newer adaptive design. The SMART moves beyond a traditional RCT to a precision approach todetermine the right treatment at the right dose with the right sequence for the right survivor-caregiver dyad. Wewill use two evidence-based interventions: Symptom Management Toolkit (SMT) and Telephone InterpersonalCounseling (TIP-C). While we have established the overall efficacy of these interventions but individuals differin responses. When an intervention does not initially work clinic logic is to either extend the timeframe orprescribe a different intervention. Yet such alternatives are seldom tested nor evidence-based. However theywill be in this study. Sample: We will enroll 298 survivors with elevated depression or anxiety who areundergoing chemotherapy or targeted therapy for a solid tumor and their 298 caregivers. Procedure: Dyadswill be initially randomized to SMT alone or TIP-C +SMT. If the survivor's elevated depression or anxiety doesnot respond to SMT alone by week 4 dyads will be re-randomized to continue with SMT to give it more time orto 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 andfidelity. Specific aims: 1) Determine if dyads in the TIP-C+SMT as compared to the SMT alone group createdby the first randomization will have: a) lower depression anxiety and summed severity of 13 other symptomsat weeks 1-12 13 and 17 (primary outcomes); b) lower use of healthcare services (hospitalizations urgentcare or emergency department [ED] visits) during 17 weeks (secondary outcomes); c) greater self-efficacysocial support and lower caregiver burden during weeks 13 and 17 (potential mediators). 2) Among non-responders to the SMT alone after 4 weeks determine if dyads assigned to TIP-C+SMT as compared to theSMT alone group created by the second randomization will have better primary and secondary outcomes andpotential mediators at weeks 5-12 13 and 17. 3) Test the interdependence in survivor's and caregiver'sprimary and secondary outcomes. 4) Determine which characteristics of the dyad are associated withresponses to the SMT alone during weeks 1-4 and optimal outcomes for the dyad during weeks 1-12 13 and17 so as to determine tailoring variables for the decision rules of individualized sequencing of interventions.Findings will be used to improve symptom management and reduce distress in survivor-caregiver dyads.