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Anxiety and depression in patients with cancer

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Updated 2023 SIO/ASCO guidelines for the management of anxiety and depression in patients with cancer.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of anxiety and depression in patients with cancer are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2023), the European Society of Medical Oncology (ESMO 2023), and the Society for Integrative Oncology (SIO/ASCO 2023). ...
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Diagnostic investigations

Assessment tools: as per ESMO 2023 guidelines, obtain regular screening and assessment for anxiety in all patients with cancer in all phases of illness.
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Medical management

Pharmacotherapy
As per ASCO 2023 guidelines:
Consider offering pharmacotherapy for depression or anxiety in patients without access to first-line treatment, expressing a preference for pharmacotherapy, or not improving following first-line psychological or behavioral management.
C
Consider offering pharmacotherapy for depression in patients with a history of treatment response to medications, severe symptoms, or accompanying psychotic features.
C

Nonpharmacologic interventions

General principles: as per ASCO 2023 guidelines, use a stepped-care model (selecting the most effective and least resource-intensive intervention based on symptom severity) when deciding on treatment for anxiety and/or depression, as well as taking into account the following variables to inform the choice of treatment approach:
psychiatric history (prior diagnoses with or without treatment)
history of substance use
prior mental health treatment response
functional abilities and/or limitations related to self-care, usual activities, and/or mobility
recurrent or advanced cancer
presence of other chronic diseases (such as cardiac disease)
member of socially and/or economically marginalized group (such as Black race, low socioeconomic status).
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More topics in this section

  • Psychosocial interventions

  • Alternative and complementary therapies

Patient education

General counseling: as per ASCO 2023 guidelines, offer information regarding depression and anxiety in all patients with cancer and any patient-identified caregiver, family member, or trusted confidant. Offer resources, such as the providers' contact information for further evaluation and treatment within or external to the facility whenever available.
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Follow-up and surveillance

Assessment of treatment response: as per ASCO 2023 guidelines, assess treatment response regularly (including pretreatment, 4 weeks, 8 weeks, and end of treatment) by a mental health professional in patients referred to and receiving psychological treatment.
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