Management of Anxiety and Depression in Adult Survivors of Cancer

Published online before print  April 19, 2023. DOI: 10.1200/JCO.23.00293

Barbara L. Andersen, Christina Lacchetti, Kimlin Ashing, Jonathan S. Berek, Barry S. Berman, Sage Bolte, Don S. Dizon, Barbara Given, Larissa Nekhlyudov, William Pirl, Annette Stanton, and Julia H. Rowland

Purpose

To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors.

Methods

A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted.

Results

The evidence base consisted of 17 systematic reviews 6 meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. 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

Recommendations 

It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. 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.

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