An evidence-based guideline to help healthcare professionals give sound advice regarding mental health to people with cancer is sorely needed.
Although there has been scarce clinical guidance, many healthcare professionals (HCPs) have been using integrative therapies like yoga and meditation to treat patients with cancer who are experiencing symptoms of anxiety and depression.
The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) recently convened a panel of experts that explored the body of research on integrative medicine to develop evidence-based recommendations on integrating these methods into practice. Linda E. Carlson, PhD, RPsych, served as one of the co-chairs of the Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology–ASCO Guideline panel.
She spoke with Physician’s Weekly regarding the significance and applicability of these guidelines.
PW: Why are these guidelines needed?
Dr. Carlson: This is the first ASCO guideline that specifically covers integrative therapies for anxiety and depression. People with cancer suffer from high levels of anxiety and depression across the disease trajectory, and effective nonpharmacologic treatments for these symptoms are needed. ASCO has published guidelines on screening, assessment, and conventional treatments for anxiety and depression in people with cancer, which were also recently updated and can be accessed here.
This more general paper is considered a companion guideline that complements the integrative therapies guideline. Whereas the general guideline covers screening, assessment, and conventional treatments for anxiety and depression, the integrative therapies guideline focuses specifically on the evidence supporting integrative therapies such as mindfulness meditation, yoga, and acupuncture (Table).
More than 50% of people with cancer worldwide use integrative therapies, and there is now sufficient evidence to provide evidence-based guidance on their use. SIO and ASCO felt it was timely to review the current evidence and produce recommendations on the use of integrative therapies for treating anxiety and depression symptoms in people with cancer across the disease trajectory.
PW: What are the most important findings of this assessment for physicians to understand?
Dr. Carlson: The strongest recommendation in the guideline across both anxiety and depression symptoms is that physicians should offer Mindfulness-Based Interventions (MBIs) to patients with cancer during active treatment and post-treatment.
MBIs are typically group-based multi-week in-person programs based on the Mindfulness-Based Stress Reduction program of Jon Kabat-Zinn, PhD. Participants are trained in mindfulness through daily mindfulness meditation practice, discussing topics such as stress and the stress response, coping, attitudes of acceptance, nonjudgment and compassion, and gentle mindful movement through Hatha yoga practices. MBIs are increasingly being offered as online programs and through digital apps.
The next strongest recommendation is yoga, which may be offered to people with cancer for both anxiety and depression symptom reduction across the treatment trajectory. During cancer treatments, music therapy, relaxation therapies, and reflexology may be offered to reduce both anxiety and depression symptoms in people with cancer. At the same time, hypnosis and lavender essential oil inhalation may help with anxiety symptoms during diagnostic and treatment procedures.
Finally, tai chi or qigong programs may help alleviate symptoms of both depression and anxiety post-treatment, and reflexology may be recommended for anxiety. Acupuncture also may be considered for women with breast cancer to reduce anxiety symptoms post-treatment.
PW: How can physicians incorporate these updated guidelines into practice?
Dr. Carlson: Because more than half of all people with cancer use integrative therapies, HCPs sorely needed an evidence-based guideline to help give sound advice on integrative therapies, both to improve outcomes for people who can benefit from these therapies and avoid harm from unproven alternative treatments. There are useful supplemental materials, including treatment algorithms and summary tables, that HCPs can use to make treatment recommendations and guide patients to safe and effective integrative therapies. HCPs can also use these to advocate for including these therapies in their treatment centers.
PW: What would you like future research to focus on?
Dr. Carlson: Many popular therapies such as massage, light therapy, energy therapies, health products/dietary supplements, and psychedelics-assisted therapy did not have enough evidence from randomized controlled clinical trials to make conclusive recommendations. This does not mean they cannot be helpful, but more research is needed. We also need more research on diverse types of cancer, in more advanced cancers, and in marginalized and racialized groups of people with cancer.
PW: What else do you feel our readers should know about your research?
Dr. Carlson: Many patients suffer from debilitating anxiety and depression, which can be managed with a variety of integrative therapies, as detailed in the recommendations. Clinicians are encouraged to refer to and advocate for cancer centers to provide access, through publicly funded healthcare, to the many evidence-based therapies highlighted in this guideline.
