Guideline recommends mindfulness interventions for cancer-related anxiety, depression
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ASCO and Society for Integrative Oncology published a guideline that recommends mindfulness-based interventions and other integrative approaches for management of cancer-related anxiety and depression.
The guideline — published in Journal of Clinical Oncology — outlines the effectiveness of strategies such as yoga, relaxation, hypnosis, acupuncture and music therapy for relieving symptoms of anxiety and depression during cancer treatment and survivorship.
This is the first guideline ASCO has produced specifically addressing integrative therapies for anxiety and depression. Society for Integrative Oncology (SIO) had produced prior guidelines on its own.
“Having these types of integrative therapies endorsed by ASCO, which is the largest mainstream cancer organization in the world, sets the stage for integrating these therapies as standard of care,” guideline lead author Linda E. Carlson, RPsych, PhD, president of SIO and professor in the department of oncology, Cumming School of Medicine at University of Calgary, told Healio. “This recommendation gives mindfulness interventions a legitimacy that might lead to support from insurance companies, administrators and policymakers.”
Carlson and colleagues assembled a panel of experts in the fields of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology and patient advocacy.
Panelists conducted a systematic literature search of reviews, meta-analyses and randomized controlled trials published between 1990 and 2023. The search yielded 110 relevant studies — encompassing more than 400 individual clinical trials — to serve as the evidence base for the guideline.
Healio spoke with Carlson about the importance of the new guideline, the increased openness to integrative medicine in cancer care, and the next steps needed to further incorporate integrative therapies into oncology.
Healio: Can you describe the recommendations in this guideline?
Carlson: There are several, but the strongest pertains to mindfulness-based interventions for people with cancer — both during and after treatment — for anxiety and depression. Other mind-body therapies like yoga also are recommended, as are things like relaxation therapies, hypnosis, music therapy and imagery, which are useful specifically for anxiety during treatment.
There also are recommendations for post-treatment tai chi, acupuncture, qigong or reflexology for treating anxiety after treatment. In terms of depression symptoms, mindfulness-based interventions, yoga, music therapy, relaxation and reflexology are recommended during active treatment, and mind-body interventions, yoga, acupuncture, tai chi or qigong, and reflexology are recommended after treatment.
Healio: What can oncologists do to help promote and optimize this guideline?
Carlson: If you look through the treatment trajectory, we have some recommendations — such as music therapy or hypnosis — to reduce anxiety as people are going through diagnosis and treatment. Those are fairly simple things that can be offered within a treatment setting by an integrative therapist. There are even some apps and online interventions that can be delivered fairly inexpensively. It’s not really difficult to gain access to some of these services. The more intensive interventions, like the mindfulness-based interventions and the yoga programs, tend to be multiweek programs. They often have been done in person in group settings. Many cancer centers and cancer support organizations are offering these more frequently. So, I think clinicians should know what resources are available in their area and be able to refer patients to theme. Cancer centers also should be investing in developing these resources for their patients if they are not already available and accessible.
Healio: What are the next steps in terms of integrative medicine guidelines in the cancer setting?
Carlson: This is part of a partnership between ASCO and SIO to develop these guidelines. We released the pain management guideline last fall, and this is the anxiety/depression guideline. We have a fatigue guideline in the works, and we’re doing a sleep guideline after that.
Healio: Is there anything else you would like to mention?
Carlson: There are other therapies people are interested in and are using that aren’t in the guideline. It’s not because they don’t work, but because there hasn’t been enough research conducted in those areas yet. So, just because something is not on the guideline doesn’t mean it doesn’t work. It just means we don’t know enough about it. This was based on only randomized controlled trials with fairly large sample sizes. It’s a very conservative guideline.
For more information:
Linda E. Carlson, RPsych, PhD, can be reached at University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4; email: l.carlson@ucalgary.ca.
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