Mindfulness Practices Recommended for Anxiety, Depression in People With Cancer
Mindfulness practices — including meditation, mindful movement, and mindfulness-based stress reduction — were formally recommended by the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology (SIO) to manage anxiety and depression in people diagnosed with cancer.
The guidelines were published online on Aug. 15, 2023, by the Journal of Clinical Oncology. Read “Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline.”
ASCO is a national organization of oncologists and other cancer care providers. ASCO develops guidelines for doctors to follow that are supported by highly credible research and experience.
SIO is an international organization of professionals from many different areas of medicine who are dedicated to studying and aiding the cancer treatment and recovery process with integrative medicine.
Anxiety and depression as cancer side effects
Anxiety is a common and normal reaction to being diagnosed with breast cancer. The shock of being diagnosed, having tests, deciding on treatments, dealing with side effects, and waiting for the results of ongoing scans — what many call “scanxiety” — are all very stressful and can make you feel worried and unsettled.
Similarly, many people diagnosed with breast cancer report feeling sad and overwhelmed. Although researchers estimate about 10% to 25% of people diagnosed with breast cancer have depression, 1 many experts believe the rate is actually much higher.
The COVID-19 pandemic, which began in 2020, made any existing anxiety and depression worse for many people, especially people with cancer. Many people receiving cancer treatment are immunocompromised and had to worry about a higher risk of severe COVID-19 infection while keeping their treatment schedules on track and dealing with side effects.
“Anxiety and depression symptoms have long been associated with lower quality of life in people with cancer,” Heather Greenlee, ND, PhD, co-chair of the SIO Clinical Practice Guideline Committee, said in a statement. “Treating these symptoms using evidence-based integrative therapies will not only improve a patient’s quality of life, but it can help them better manage their care too. Now we know which therapies could have the biggest impact.”
ASCO and SIO developed the guidelines to help doctors know which integrated, or complementary, therapies can effectively help manage anxiety and depression.
Guideline recommendations
To develop the guidelines, a panel of ASCO and SIO experts reviewed research published between 1990 and 2023 on complementary therapies to ease anxiety and depression in people diagnosed with cancer.
Doctors should offer mindfulness-based techniques, including meditation, mindful movement, and mindfulness-based stress reduction to ease anxiety and depression in people receiving cancer treatment and people who’ve completed cancer treatment.
Mindful movement means focusing as much of your attention as possible on the movements of your body and your breathing while doing exercises or stretches. Certain forms of yoga are considered mindful movement, as is tai chi. But as long as you’re focusing on your movement and breath, just about any type of exercise or stretching could qualify.
Mindfulness-based stress reduction is a program developed by Jon Kabat-Zinn, professor emeritus of medicine at the University of Massachusetts Medical School. The program uses mindfulness meditation, body awareness, yoga, and looking at patterns of behavior, thinking, and feeling.
The studies looking at mindfulness-based techniques to manage anxiety and depression were high quality and the evidence was strong.
Doctors may recommend yoga to people diagnosed with breast cancer to ease anxiety and depression during active treatment and after treatment.
The quality of the evidence was intermediate.
For people diagnosed with other types of cancer, the evidence was weak.
Doctors may offer hypnosis to people to ease anxiety during tests to diagnose cancer and during cancer treatment.
The quality of the evidence was intermediate.
Doctors may offer relaxation therapies to people to ease anxiety and depression during active cancer treatment. Deep breathing and tensing and releasing individual muscles are two examples of relaxation therapies.
The quality of the evidence was intermediate.
Doctors may recommend acupuncture to people diagnosed with breast cancer to ease anxiety after they complete treatment.
The quality of the evidence was intermediate.
Doctors may recommend tai chi to people diagnosed with breast cancer to ease anxiety and depression after they complete treatment.
The quality of the evidence was intermediate.
Doctors may offer music therapy or music-based techniques to people to ease anxiety and depression during active cancer treatment.
The quality of the evidence was low.
Doctors may offer reflexology to people to ease anxiety and depression during active treatment and after they complete treatment. Reflexology is a Chinese medicine technique that uses gentle pressure on specific places on your feet, hands, and ears to ease stress.
The quality of the evidence was low.
Doctors may recommend inhaling lavender essential oil (also called aromatherapy) to people to ease anxiety during tests to diagnose cancer and during treatment.
The quality of the evidence was low.
Doctors should not offer expressive writing to ease depression in people diagnosed with cancer.
The quality of the evidence was intermediate.
The experts who developed the guidelines said there was not enough evidence to make recommendations for or against the following techniques to ease anxiety and depression in people with cancer:
light therapy
psilocybin therapy
massage therapy
dance or movement therapy
laughter therapy
healing touch
acupressure
biofeedback
energy healing
melatonin
other natural products or supplements
“The goal of these guidelines is to inform as many clinicians and people living with cancer as possible about where the evidence lies to support the best clinical outcomes possible for all people with cancer,” added Linda E. Carlson, PhD, president of SIO, professor of oncology at the University of Calgary, and co-chair of the guideline. “We believe this latest guideline accomplishes that for those suffering from anxiety and depression symptoms.”
What this means for you
If you’re feeling symptoms of anxiety or depression because of a breast cancer diagnosis or treatment, you may want to show your doctor these guidelines and ask about mindfulness practices that might be right for you.
Many hospitals and treatment centers now have integrated oncology services designed to work together with traditional cancer therapies. If you’re not familiar with these services, ask someone on your care team for more information or to set up an appointment for you.
If you’re also having pain related to breast cancer or breast cancer treatment, be sure to read the ASCO-SIO guidelines on complementary therapies for cancer pain.
Charles, C. et al. “Characterization of Depressive Symptoms Trajectories AFter Breast Cancer Diagnosis in Women in France, JAMA Network Open, April 14, 2022. Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791036
— Last updated on October 18, 2023 at 6:38 PM