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New Guidelines for Integrative Care of Cancer-Related Anxiety and Depression

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How You Can Use the ASCO-SIO Review and Guidelines

Recently, I wrote about using the American Society for Clinical Oncology and Society for Integrative Oncology’s (ASCO-SIO) joint guidelines on integrative approaches to manage cancer pain. The ASCO-SIO review committee has assembled a similar set of guidelines on integrative approaches for managing anxiety and depression in people with cancer. 

Key findings on mindfulness-based interventions and yoga

If you have worked with patients for any length of time, you have probably formed your own opinions about what relieves anxiety and depression during and after cancer treatment. Most noteworthy in the new ASCO-SIO guidelines is probably the strong evidence for mindfulness-based interventions, with an evidence base including nearly 30 randomized controlled trials.

An example of mindfulness-based stress reduction shown to be effective comprised several weeks of virtual or in-person meetings that included a variety of healing modalities: meditation, gentle movement, education on the mind-body connection, and interpersonal support and conversation. 

The other intervention for which there is strong evidence is yoga for breast cancer. Weekly or twice weekly yoga classes have been shown to confer significant benefits in relieving anxiety and depression symptoms. The evidence for this includes half a dozen randomized controlled trials.

Evidence is not yet as strong for using this intervention with other types of cancer, but it can still be recommended. Yoga does have strength and mobility benefits, and it can help patients become more aware of their breathing and attention.

A broad range of integrative options

During cancer treatment, some patients experience extreme fatigue – so much so that a group mindfulness session, even a virtual one, or a yoga class might require more physical effort than one can muster.

The encouraging news is that a number of modalities requiring very little physical effort are also shown to help reduce anxiety and depression. These include aromatherapy, specifically with lavender oil for relaxation (a trained aromatherapist can recommend other essential oils for patients who are averse or allergic to this particular scent). They also include reflexology, a massage limited to specific zones on the feet, during which patients can simply sit or lie in a comfortable position, and music therapy.  

After completing cancer treatment, patients who are feeling more energetic can certainly continue using music to relieve anxiety and depression and may want to add gentle movement. Practices I personally recommend to many patients, tai chi and qi gong, are recommended in the ASCO-SIO guidelines to help relieve post-treatment anxiety and depression. They also contribute to physical energy and the regaining of strength, balance, and a sense of wellbeing.

Helping patients access integrative approaches for anxiety and depression

Patients differ enormously in their capacity to access integrative care. Some of my patients are fairly dependent on volunteer transportation, such as veterans’ or care facilities’ bus services, to attend even basic treatment appointments. On the other end of the spectrum are patients receiving care at well-known cancer centers where integrative modalities are often available, including acupuncture, various classes, and even bedside music therapy or aromatherapy.

It is important to help those patients and their caregivers find integrative care resources they can access readily, close to their homes if needed, at an affordable cost. Community acupuncture programs are available in many communities. Schools of massage may offer reflexology at a reduced cost by trainees working under supervision. Yoga is readily available online, as are tai chi and qi gong. For patients who would like to attend classes in person, those are often available through community resources such as schools, libraries, and Meetup groups.

When suggesting a specific type of intervention, a sensitive query such as, “Would you be able to do something like that?” can help elicit patients’ and caregivers’ interest in the intervention as well as their capacity to access it.

Patients in more rural or isolated communities may need assistance to creatively access integrative health resources, while those in busy urban centers may need help sorting through all the available options and have access to options with a specialized cancer orientation.

The importance of communication about integrative care

Support for integrative oncology care is growing, with both patients and providers becoming more aware of them and interested in using these approaches. However, there is a communication disconnect between patients and providers, as we found in a survey of patient and oncologist attitudes we conducted last year. Sharing the information from the ASCO-SIO guidelines with your patients and talking with them about their interest in integrative cancer care is an important step toward closing that gap and providing whole person care for anxiety and depression.

ASCO-SIO Guidelines for Integrative Anxiety and Depression Therapies for Cancer
During cancer treatmentAfter cancer treatment ends
(meditation, either sitting or walking, and yoga)
(meditation, either sitting or walking, and yoga)
Music therapyReflexology
ReflexologyTai chi
Relaxation therapyQi gong


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