Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology–ASCO Guideline

Abstract

PURPOSE To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations. RESULTS The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline. RECOMMENDATIONS Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment. DISCUSSION Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed. Additional information is available at www.asco.org/survivorship-guidelines .

Telehealth and Technology

“…Patients with cancer are disproportionately afflicted with anxiety and depression, with estimated prevalence rates of 18% and 20%, respectively. 38 The most recent American Society of Clinical Oncology guidelines on the management of anxiety and depression in patients with cancer still refer to digital health interventions such as telehealth as a "future direction"; we anticipate that this will be an area for increased and early adoption of telehealth technology. Telehealth applications also may find a role in supporting the developmental and social needs of children, adolescents, and young adults with cancer, particularly those living in rural or isolated settings.…”

Conceptualizing an Integrative Multiple Myeloma Care: The Role of Nutrition, Supplements, and Complementary Modalities

“…The hallmarks of many mind–body interventions are mindfulness and intention to berating, gentle touch, movement, and spirituality. Recent IO-related clinical guidelines on pain, depression, and anxiety co-published by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) recommend mind–body medicine for the following indications: hypnosis in patients who experience procedural pain; MBIs, yoga, relaxation, and music therapy for treating symptoms of anxiety during active treatment; MBIs, yoga, tai chi, and/or qigong for treating anxiety symptoms after cancer treatment; MBIs, yoga, music therapy, and relaxation for depression symptoms during oncology treatment; and MBIs, yoga, and tai chi and/or qigong post-treatment depression [ 102 , 103 ]. In the field of Multiple Myeloma, Lamers et al, reported that as many as 52% of patients desired psychosocial interventions near diagnosis, where relaxation techniques were the most common preferred modality reported by 21% of patients [ 104 ].…”

Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: SIO-ASCO Guideline Summary and Q&A

“…Although there is some evidence supporting the use of a few dietary supplements for treatment of depression and anxiety in the general population, 25 there is inconclusive evidence that those supplements are safe and effective for people diagnosed with cancer. 10 Furthermore, some supplements used for anxiety or depression may pose high risk of supplement-drug interactions, such as Kava Kava (Piper methysticum) and St Johns Wort (Hypericum perforatum), 26,27 which could be especially detrimental for patients engaged in active cancer treatment.…”