Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2023 Oct 1;41(28):4562-4591. doi: 10.1200/JCO.23.00857. Epub 2023 Aug 15.
To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer.
The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations.
The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline.
Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment.
Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.
为医疗保健提供者提供循证建议，以采用综合方法来管理患有癌症的成年人的焦虑和抑郁症状。
肿瘤整合治疗协会（Society for Integrative Oncology）和美国临床肿瘤学会（ASCO）召集了一个由肿瘤整合治疗、肿瘤内科、肿瘤放射治疗、肿瘤外科、姑息治疗、社会科学、身心医学、护理、方法学和患者权益倡导代表组成的专家小组。文献检索包括 1990 年至 2023 年发表的系统评价、荟萃分析和随机对照试验。感兴趣的结果包括使用经过验证的心理计量工具测量的焦虑或抑郁症状以及不良事件。专家小组成员使用该证据和与指南纳入决策支持方法的非正式共识，制定了基于证据的指南建议。
文献检索确定了 110 项相关研究（30 项系统评价和 80 项随机对照试验），为该指南的证据基础提供了信息。
对于在积极治疗期间治疗焦虑症状，建议采用正念干预（MBIs）、瑜伽、放松、音乐治疗、反射疗法和芳香疗法（吸入）；对于癌症治疗后治疗焦虑症状，建议采用 MBIs、瑜伽、针灸、太极和气功以及反射疗法。对于抑郁症状，建议在治疗期间采用 MBIs、瑜伽、音乐治疗、放松和反射疗法，治疗后采用 MBIs、瑜伽和太极和气功。
讨论了患者与医疗保健提供者沟通、健康差异、合并医疗状况、成本影响、指南实施、提供者培训和认证、以及天然保健品的质量保证等问题。虽然 MBI 和瑜伽等几种方法似乎有效，但证据基础存在一些局限性，包括评估偏倚风险、治疗方法不标准化、研究样本缺乏多样性、缺乏积极对照条件以及未来的研究方向。更多信息可在 www.asco.org/survivorship-guidelines 上获取。
