ASCO Updates Guidelines on Managing Anxiety and Depression in Cancer Survivors
The American Society of Clinical Oncology (ASCO) has released updated guidelines on managing anxiety and depression in people who have been diagnosed with cancer.
The guidelines were published online on April 19, 2023, by the Journal of Clinical Oncology. Read “Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guidelines Update.”
ASCO is a national organization of oncologists and other cancer care providers. ASCO develops guidelines that are supported by highly credible research and experience for doctors to use when recommending treatments and testing.
To develop the guidelines, a group of experts reviewed 61 studies published between 2013 and 2021.
“Current evidence supports that the recommended treatment interventions for depression and anxiety are effective therapeutic options. However, it is acknowledged that availability of mental health services, ease of access, time to service provision, and cost are important considerations that may vary across treatment settings. The choice of intervention to offer patients should be based on shared decision making, taking into account availability, accessibility, patient preference, likelihood of adherence, and cost,” the experts noted.
Guideline recommendations
The guidelines address three areas:
general management principles
treatment and care options for depressive symptoms
treatment and care options for anxiety symptoms
Anyone diagnosed with cancer, as well as any caregiver, family member, or trusted confidant identified by the person with cancer, should be offered information about anxiety and depression.
This same group of people also should be offered resources, such as contact information for further evaluation and treatment.
Information on anxiety and depression should be culturally informed and linguistically appropriate. The information can be in the form of a conversation, written, or online.
Doctors should use a stepped-care model. This means they should select the treatment for depression or anxiety that is the most effective and uses the least resources based on the severity of a person’s symptoms.
Other factors to consider when deciding on treatment approaches include psychiatric history, history of substance abuse, and other health conditions.
The treatments offered by mental health professionals should be based on research. Treatments should be tailored based on linguistic, cultural, and socioecological contexts.
When referring people for psychological care, doctors should make every effort to reduce barriers and make follow-through as easy as possible. After making the referral, doctors should check on how satisfied the person is with the psychological care and help the person overcome any barriers that come up.
If a person has symptoms of both depression and anxiety, treating the depressive symptoms should be the priority. Alternatively, doctors can recommend treatments that address symptoms of both depression and anxiety.
When people are receiving psychological treatment, mental health professionals should regularly assess how they’re responding to treatment; for example, before treatment starts, four weeks after treatment starts, eight weeks after treatment starts, and when treatment is complete.
If a person is prescribed medicine for anxiety or depression, the treating doctor should regularly assess the response using a standard tool, including assessing symptom relief, side effects, and satisfaction. If the symptoms are not getting better or are getting worse, the treating doctor should re-evaluate and revise the treatment plan.
After eight weeks of treatment, if there is little or no improvement in symptoms, the person is not satisfied, or there are barriers to treatment, the treating doctor should adjust the treatment plan.
If people have moderate to severe depressive symptoms, doctors should give culturally informed and linguistically appropriate information to patients and their caregivers, family members, or trusted confidants. This could include information on common symptoms, how to tell if symptoms are getting worse, and when to contact the medical team.
For people with moderate depressive symptoms, doctors should offer individual or group therapy with any of these treatment options:
cognitive therapy or cognitive behavioral therapy (CBT)
behavioral activation
structured physical activity and exercise
mindfulness-based stress reduction
psychosocial interventions such as relaxation, problem-solving, or other techniques
For people with several depressive symptoms, doctors should offer individual therapy with any of these treatment options:
cognitive therapy or CBT
behavioral activation
mindfulness-based stress reduction
interpersonal therapy
Doctors may offer medicine for depression to people who do not have access to psychological or behavioral management options, people who prefer medicine, or people who don’t improve on psychological or behavioral management options.
If people have moderate to severe anxiety symptoms, doctors should give culturally informed and linguistically appropriate information to patients and their caregivers, family members, or trusted confidants. This could include information on symptoms, how to tell if symptoms are getting worse, and contact information for the medical team.
For people with moderate symptoms of anxiety, doctors should offer individual or group therapy with any of these treatment options:
CBT
behavioral activation
structured physical activity and exercise
psychosocial interventions such as relaxation, problem-solving or other techniques
For people with severe symptoms of anxiety, doctors should offer individual therapy with any of these treatment options:
CBT
behavioral activation
mindfulness-based stress reduction
interpersonal therapy
Doctors may offer medicine for anxiety to people who do not have access to psychological or behavioral management options, people who prefer medicine, or people who don’t improve on psychological or behavioral management options.
What this means for you
If you’re depressed or anxious after being diagnosed with breast cancer, you are not alone. Feelings of anxiety and depression can be triggered at different points in time if you’ve been diagnosed with breast cancer:
after the initial diagnosis
during treatment
during on-going treatment if you’ve been diagnosed with metastatic disease
after treatment
during long-term follow-up when you have tests to monitor for any recurrence
These updated guidelines can help you and your doctor make the best decisions about ways to manage the symptoms of these two conditions and help you live your best life.
Learn more about taking care of your mental health after being diagnosed with breast cancer.
Updated on August 10, 2023