Patient description: The patient is a 47-year-old Asian woman complaining of persistent feelings of sadness. She lost interest in activities she used to enjoy. She states that her mood is mostly depressed for the past 3 weeks. She also lost her appetite , which led to about 5kg weight loss. She complains of loss of energy and feelings of worthlessness nearly every day. She is not using any drugs and she does not smoke. She doesn't drink alcohol. She used to exercise every day for at least 30 min. But she doesn't have enough energy to do so for the past 3 weeks. She also has some digestive issues recently. She is married and has 4 children. She is menopausal. Her husband was recently diagnosed with colon cancer and he is starting his chemotherapy. There is nothing remarkable in her past medical history and her drug history is only positive for Vit D3 1000 units daily. Her family history is negative for any psychologic problems. Her HAM-D score is 20.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Stage IV Esophageal Adenocarcinoma Stage IV Esophageal Squamous Cell Carcinoma Stage IV Gastric Cancer Stage IV Adenocarcinoma of the Gastroesophageal Junction Stage IVA Esophageal Adenocarcinoma Stage IVA Esophageal Squamous Cell Carcinoma Stage IVA Gastric Cancer Stage IVA Adenocarcinoma of the Gastroesophageal Junction Stage IVB Esophageal Adenocarcinoma Stage IVB Esophageal Squamous Cell Carcinoma Stage IVB Gastric Cancer Stage IVB Gastroesophageal Junction Adenocarcinoma Metastatic Anal Canal Carcinoma Metastatic Colorectal Carcinoma Metastatic Esophageal Carcinoma Metastatic Gastric Carcinoma Metastatic Gastroesophageal Junction Adenocarcinoma Metastatic Hepatocellular Carcinoma Metastatic Malignant Digestive System Neoplasm Metastatic Small Intestinal Carcinoma Pancreatobiliary Carcinoma Pathologic Stage IV Gastric Cancer AJCC v8 Pathologic Stage IVA Esophageal Adenocarcinoma AJCC v8 Pathologic Stage IVA Esophageal Squamous Cell Carcinoma AJCC v8 Pathologic Stage IVB Esophageal Adenocarcinoma AJCC v8 Pathologic Stage IVB Esophageal Squamous Cell Carcinoma AJCC v8 Pathologic Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8 Postneoadjuvant Therapy Stage IV Esophageal Squamous Cell Carcinoma AJCC v8 Postneoadjuvant Therapy Stage IV Gastric Cancer AJCC v8 Postneoadjuvant Therapy Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8 Postneoadjuvant Therapy Stage IVA Esophageal Adenocarcinoma AJCC v8 Postneoadjuvant Therapy Stage IVA Esophageal Squamous Cell Carcinoma AJCC v8 Postneoadjuvant Therapy Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8 Postneoadjuvant Therapy Stage IVB Esophageal Adenocarcinoma AJCC v8 Postneoadjuvant Therapy Stage IVB Esophageal Squamous Cell Carcinoma AJCC V8 Postneoadjuvant Therapy Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8 Stage IV Anal Cancer AJCC v8 Stage IV Colorectal Cancer AJCC v8 Stage IV Hepatocellular Carcinoma AJCC v8 Stage IVA Colorectal Cancer AJCC v8 Stage IVA Hepatocellular Carcinoma AJCC v8 Stage IVB Colorectal Cancer AJCC v8 Stage IVB Hepatocellular Carcinoma AJCC v8 Stage IVC Colorectal Cancer AJCC v8 Patients must have a histologically, cytologically, or radiographically confirmed metastatic gastrointestinal (GI) malignancy (esophageal, gastroesophageal, gastric, small intestine, hepatocellular, pancreaticobiliary, colorectal, or anal cancer) Patients must be receiving immunotherapy (checkpoint inhibitor or CTLA4 inhibitor) with overall response of progressive disease by Patients must have at least two metastases which are individually progressing as per one of which can be safely unirradiated as adjudicated by the treating radiation oncologist (e.g. lesions for which small increases in dimensions are unlikely to precipitate significant symptoms) Patients must have 1-5 sites of disease meeting standard-of-care indications for palliative radiation therapy as adjudicated by the treating radiation oncologist. For example Symptomatic disease causing pain, bleeding, dyspnea, dysphagia, or nausea At-risk for neurologic, respiratory, cardiovascular, gastrointestinal, musculoskeletal, or hepatobiliary compromise Evaluation by a radiation oncologist within 28 days of study registration Absolute neutrophil count at least 1,200/microliter (mcL) Platelets at least 75,000/mcL Hemoglobin at least 9 g/dL (unless documented bleeding where at least 8 g/dL is permitted)  Enrollment on immunotherapy clinical trial for which radiation therapy is not permitted Administration of radiation therapy within 4 weeks prior to study enrollment Treatment with systemic corticosteroids or other immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, methotrexate, anti-tumor necrosis factor (TNF) agents, etc) within 2 weeks of enrollment Systemic corticosteroids for adrenal insufficiency is not excluded Systemic corticosteroids for acute asthma, bronchitis, or chronic obstructive pulmonary disease exacerbation (less than 2 weeks in duration) is not excluded Systemic corticosteroids used for short-term purposes (e.g. nausea, anti-inflammatory indications for brain/spinal metastases or radiation-induced pain flares) are not excluded Radiation therapy is contraindicated as adjudicated by the radiation oncologist