The Ohio State University, Columbus, OH.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2023 Jun 20;41(18):3426-3453. doi: 10.1200/JCO.23.00293. Epub 2023 Apr 19.
To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors.
A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted.
The evidence base consisted of 17 systematic reviews ± 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.
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.Additional information is available at www.asco.org/survivorship-guidelines.
更新美国临床肿瘤学会关于成人癌症幸存者焦虑和抑郁管理的指南。
一个多学科专家小组召开会议更新该指南。对 2013-2021 年发表的证据进行了系统回顾。
证据基础包括 17 项系统评价（9 项为心理社会干预，4 项为身体锻炼，3 项为正念减压[MBSR]，1 项为药物干预）和另外 44 项随机对照试验。心理、教育和心理社会干预可改善抑郁和焦虑症状。癌症幸存者药物治疗抑郁和焦虑的证据不一致。注意到少数族裔群体幸存者的缺失，并将其确定为为少数民族提供高质量护理的一个重要考虑因素。
建议使用分级护理模式，即根据症状严重程度提供最有效且资源消耗最少的干预措施。应向所有肿瘤患者提供有关抑郁和焦虑的教育。对于中度抑郁症状的患者，临床医生应提供认知行为疗法（CBT）、行为激活（BA）、MBSR、结构化身体活动或经验证的心理社会干预。对于中度焦虑症状的患者，临床医生应提供 CBT、BA、结构化身体活动、接受和承诺疗法或心理社会干预。对于重度抑郁或焦虑症状的患者，临床医生应提供认知疗法、BA、CBT、MBSR 或人际疗法。对于无法获得一线治疗、偏好药物治疗、以前对药物治疗反应良好或一线心理或行为管理后未改善的患者，治疗临床医生可以为其提供药物治疗方案。更多信息可在 www.asco.org/survivorship-guidelines 上获取。
