Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation

Abstract

Purpose: A Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer was identified for adaptation.

Methods: American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The guideline was reviewed for developmental rigor and content applicability.

Results: On the basis of content review of the pan-Canadian guideline, the ASCO panel agreed that, in general, the recommendations were clear, thorough, based on the most relevant scientific evidence, and presented options that will be acceptable to patients. However, for some topics addressed in the pan-Canadian guideline, the ASCO panel formulated a set of adapted recommendations based on local context and practice beliefs of the ad hoc panel members. It is recommended that all patients with cancer be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care. Assessment should be performed using validated, published measures and procedures. Depending on levels of symptoms and supplementary information, differing treatment pathways are recommended. Failure to identify and treat anxiety and depression increases the risk for poor quality of life and potential disease-related morbidity and mortality. This guideline adaptation is part of a larger survivorship guideline series.

Conclusion: Although clinicians may not be able to prevent some of the chronic or late medical effects of cancer, they have a vital role in mitigating the negative emotional and behavioral sequelae. Recognizing and treating effectively those who manifest symptoms of anxiety or depression will reduce the human cost of cancer.

Fig 1.

Depression algorithm. Data adapted with permission. GAD, generalized anxiety disorder; PHQ-9, nine-item personal health questionnaire. In this algorithm, the use of the word “depression” refers to the PHQ-9 screening score and not to a clinical diagnosis: (1) initial diagnosis/start of treatment, regular intervals during treatment, 3, 6, and 12 months after treatment, diagnosis of recurrence or progression, when approaching death, and during times of personal transition or reappraisal such as family crisis; (2) presence of symptom in the last 2 weeks (rated as 0 = “not at all,” 1 = “several days,” 2 = “more than half the days,” and 3 = “nearly every day”); (3) content of remaining seven items: sleep problems, low energy, appetite, low self-view, concentration difficulties, motor retardation or agitation, and thoughts of self-harm. Care map for depression in adults with cancer. Data adapted with permission. CBT, cognitive behavior therapy..

Fig 1.

Depression algorithm. Data adapted with permission. GAD, generalized anxiety disorder; PHQ-9, nine-item personal health questionnaire. In this algorithm, the use of the word “depression” refers to the PHQ-9 screening score and not to a clinical diagnosis: (1) initial diagnosis/start of treatment, regular intervals during treatment, 3, 6, and 12 months after treatment, diagnosis of recurrence or progression, when approaching death, and during times of personal transition or reappraisal such as family crisis; (2) presence of symptom in the last 2 weeks (rated as 0 = “not at all,” 1 = “several days,” 2 = “more than half the days,” and 3 = “nearly every day”); (3) content of remaining seven items: sleep problems, low energy, appetite, low self-view, concentration difficulties, motor retardation or agitation, and thoughts of self-harm. Care map for depression in adults with cancer. Data adapted with permission. CBT, cognitive behavior therapy..

Fig 2.

Anxiety algorithm. Data adapted with permission. GAD-7, Generalized Anxiety Disorder-7 scale; w/wo, with or without. In this algorithm, the use of the word “anxiety” refers to GAD-7 scale scores and not to clinical diagnosis of anxiety disorder(s): (1) initial diagnosis/start of treatment, regular intervals during treatment, 3, 6, and 12 months after treatment, diagnosis of recurrence or progression, when approaching death, and during times of personal transition or reappraisal such as family crisis; (2) presence of symptom in the last 2 weeks (rated as 0 = “not at all,” 1 = “several days,” 2 = “more than half the days,” and 3 = “nearly every day”); (3) content of items: feeling nervous, anxious, on edge, cannot stop/control worry, worry too much, trouble relaxing, restlessness, easily annoyed, irritable, and feeling afraid. Final item regarding difficulty of the problems. Care map for generalized anxiety in adults with cancer. Data adapted with permission. CBT, cognitive behavior therapy; GAD, generalized anxiety disorder; SSRI, selective serotonin reuptake inhibitor.

Fig 2.

Anxiety algorithm. Data adapted with permission. GAD-7, Generalized Anxiety Disorder-7 scale; w/wo, with or without. In this algorithm, the use of the word “anxiety” refers to GAD-7 scale scores and not to clinical diagnosis of anxiety disorder(s): (1) initial diagnosis/start of treatment, regular intervals during treatment, 3, 6, and 12 months after treatment, diagnosis of recurrence or progression, when approaching death, and during times of personal transition or reappraisal such as family crisis; (2) presence of symptom in the last 2 weeks (rated as 0 = “not at all,” 1 = “several days,” 2 = “more than half the days,” and 3 = “nearly every day”); (3) content of items: feeling nervous, anxious, on edge, cannot stop/control worry, worry too much, trouble relaxing, restlessness, easily annoyed, irritable, and feeling afraid. Final item regarding difficulty of the problems. Care map for generalized anxiety in adults with cancer. Data adapted with permission. CBT, cognitive behavior therapy; GAD, generalized anxiety disorder; SSRI, selective serotonin reuptake inhibitor.