In a guideline from the American Society of Clinical Oncology, a multimodal, stepped-care approach is recommended for managing anxiety and depression in adult cancer survivors. “Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management,” the authors conclude.
The evidence comes from 17 systematic reviews with or without meta-analyses for psychosocial interventions, physical exercise, mindfulness-based stress reduction [MBSR], and pharmacologic interventions, and an additional 44 randomized controlled trials. “Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety,” the authors write. “Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations.”
“It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity,” the guideline states. “All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.”
