Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update
- Study type
- Clinical guideline
- Study name
- ASCO Anxiety & Depression Survivors 2023
- Design
- Clinical practice guideline update based on a systematic review of evidence published from 2013 to 2021 and consensus of a multidisciplinary expert panel
- Sample size
- 17 systematic reviews ± meta-analyses and 44 randomised controlled trials
- Source
- JCO · 2023
In plain words
Anxiety and depression are common in cancer survivors, and they can be treated. This guideline recommends that all patients are told about these problems and that treatment is chosen according to how severe the symptoms are. Talking therapy, education and structured physical activity are usually the first choices, and medicines are considered in particular situations. If you have symptoms such as lasting sadness or worry, talk to your doctor or care team.
Key points
Key guideline recommendations
- Level of evidence/strength of recommendation in the full guideline
A stepped-care model is recommended; that is, the most effective and least resource-intensive intervention should be offered according to symptom severity.
- Level of evidence/strength of recommendation in the full guideline
Education about depression and anxiety should be offered to all oncology patients.
- Level of evidence/strength of recommendation in the full guideline
For patients with moderate symptoms of depression, clinicians should offer cognitive behavioural therapy (CBT), behavioural activation (BA), mindfulness-based stress reduction (MBSR), structured physical activity or empirically supported psychosocial interventions.
- Level of evidence/strength of recommendation in the full guideline
For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy or psychosocial interventions.
- Level of evidence/strength of recommendation in the full guideline
For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR or interpersonal therapy.
- Level of evidence/strength of recommendation in the full guideline
Treating clinicians may offer a pharmacological regimen for depression or anxiety to patients who have no access to first-line therapy, who prefer drug treatment, who have previously responded well to drug treatment or who have not improved after first-line psychological or behavioural management.
Study population
Adult cancer survivors with anxiety and depression. Details of the study inclusion criteria are given in the full guideline.
Endpoints
The aim of the guideline is to update the American Society of Clinical Oncology (ASCO) recommendations for managing anxiety and depression in adult cancer survivors. The evidence base included psychological, educational and psychosocial interventions, exercise, mindfulness-based stress reduction and pharmacological interventions.
Safety and side effects
The abstract gives no data on adverse events. For safety details of the interventions, particularly drug treatments, see the full guideline.
Clinical significance and place in guidelines
This guideline proposes a stepped-care model for managing anxiety and depression in adult cancer survivors. In this model, psychosocial and behavioural interventions matched to symptom severity are first line, and drug therapy is considered in specific circumstances. This is an official ASCO document; its adoption in other societies' guidelines and the availability of the interventions at each centre should be checked separately.
Limitations
Evidence for drug treatment of depression and anxiety in cancer survivors was inconsistent. Survivors from minority groups were under-represented in the studies, an important consideration for delivering high-quality care to ethnic minority populations.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.