In a recent publication in the Journal of Clinical Oncology, researchers provided information from a multidisciplinary expert panel that updated the American Society of Clinical Oncology guidelines on the management of anxiety and depression in adult cancer survivors.
The expert panel systematically reviewed relevant published studies between 2013 and 2021 to develop updated clinical practice guideline recommendations. This guideline update aimed to gather and examine the evidence published since the 2014 guideline. The evidence base involved 17 systematic reviews ± meta-analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions) and an additional 44 randomized, controlled trials.
The expert panel issued recommendations for managing and treating anxiety and depression in adult cancer survivors, which often occurs more frequently in cancer patients compared with the general population. The panel indicated that depression and anxiety in cancer patients are often unrecognized or overlooked and, therefore, untreated, and symptoms are often perceived as a normal reaction to a cancer diagnosis.
The updated guidelines recommends that oncology professionals and other healthcare providers involved in the care of adult cancer survivors follow a stepped-care approach, opting for the most effective and least resource-intensive intervention established on the severity of symptoms when selecting treatment for anxiety and/or depression.
The experts noted that psychological, educational, and psychosocial interventions resulted in improvements in depression and anxiety, and evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent.
The experts indicated that all oncology patients should be offered education regarding depression and anxiety. Clinicians should provide cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions for patients with moderate symptoms of depression.
For patients with moderate anxiety symptoms, clinicians should recommend CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions.
For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy.
Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.
The authors wrote, “This guideline provides detailed and medically sound compilations of updates, insights, advice, and recommendations for depression and/or anxiety in adult cancer survivors. However, they were developed in the context of available mental health care and may not be applicable within other resource settings.”
The authors also added, “It is the view of the Expert Panel that healthcare providers and healthcare system decision-makers should be guided by these recommendations. However, the authors acknowledge that not all recommended interventions for the management of depression and/or anxiety in survivors of adult cancer are available in resource-limited environments. When services are not available, clinicians should opt for other accessible interventions.”
In a press release, one of the authors and Florida Cancer Specialists & Research Institute, LLC medical oncologist Barry Berman MD, MS, stated, “As clinicians, we must be mindful of the emotional toll that a cancer diagnosis and the associated treatment bears on our patients. While, yes, it is expected, it cannot be ignored. We must treat our patients from a holistic approach. Addressing their mental health is essential to delivering favorable outcomes, especially when it comes to cancer.”
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