Anxiety, depression guideline for cancer survivors favors psychology over pharmacology
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Key takeaways:
- Anxiety and depression treatment should follow a stepped-care approach based on the severity of symptoms.
- Pharmacologic intervention is not recommended as first-line treatment except under specific conditions.
ASCO has updated its guidelines on the management of anxiety and depression for adult cancer survivors.
The revised guidance — published in Journal of Clinical Oncology — recommends cancer-care professionals and advocates follow a stepped-care approach that emphasizes psychological rather than pharmacologic interventions.
The importance of proper management of depression and anxiety among those diagnosed with cancer cannot be understated, according to Barbara L. Andersen, PhD, distinguished university professor in the department of psychology at The Ohio State University and lead author of the expert panel that revised the guidelines.
“There have been numerous studies showing that depression and anxiety at diagnosis and thereafter affect survival,” Andersen told Healio. “Even after controlling for cancer treatment, a continued trajectory of depressive symptoms after a cancer diagnosis is a known contributor to poorer survival outcomes.”
Motivation to update
ASCO brought together a multidisciplinary panel of experts to update its 2014 recommendations, which identified specific measurements to assess anxiety and depression while advising relevant treatments. However, a systematic review of evidence had not been performed at the time, according to Andersen.
“The main goal of this effort was to reaffirm the recommendations for screening through a systematic review of the treatments for anxiety and depression,” she said.
The expert panel conducted a systematic review of relevant published studies between 2013 and 2021 to develop the updated clinical practice guideline recommendations.
“These guidelines are focused on cancer care providers, but it’s a document that could benefit patients and caregivers, as well,” Andersen said. “Patients need to know that they are entitled to treatment for their symptoms.”
Recommendations
The overarching recommendation in the updated guideline is that clinicians use a stepped-care model to diagnose and treat anxiety and depression based on selection of the most effective and least resource-intensive intervention commensurate with severity of the patient’s symptoms.
The most significant changes to the guideline apply to patients with moderate or severe depression symptoms, according to Andersen.
Survivors with moderate symptoms should be recommended — in a group or individual setting — options for cognitive behavioral therapy, behavioral activation, structured physical activity and exercise, mindfulness-based stress reduction, or other empirically supported interventions, according to the guideline.
Patients with severe symptoms should be offered individual treatment with cognitive behavioral therapy, behavioral activation, mindfulness-based stress reduction or interpersonal therapy, according to the guideline.
“It’s important that providers realize that these recommended treatments are psychological in nature,” Andersen told Healio.
Due to a lack of strong evidence, “pharmacotherapy is not recommended as a first-line treatment — neither alone nor in combination with other treatments,” she added. “It’s only under specific conditions that pharmacotherapy should be considered.”
Those conditions include situations where there is a lack of available mental health resources, patients have previously responded well to pharmacotherapy for moderate or severe symptoms, or for patients with severe agitated symptoms of depression or depression with psychotic features, Andersen noted.
For more information:
American Society of Clinical Oncology can be reached at 2318 Mill Road, Suite 800, Alexandria, VA 22314; e-mail: guidelines@asco.org.
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