There is a critical need for evidence-based guidelines to help healthcare professionals provide sound mental health advice to people with cancer.
Although there is little clinical advice, many healthcare professionals use integrative therapies such as yoga and meditation to treat cancer patients who have symptoms of anxiety and depression.
THE Integrative Oncology Society (SIO) and the American Society of Clinical Oncology (ASCO) recently convened an expert panel that explored the body of research on integrative medicine to develop evidence-based recommendations for integrating these methods into practice.. Linda E. Carlson, PhD, RPsychwas 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 Doctors’ Weekly regarding the importance and applicability of these guidelines.
PG: Why are these guidelines necessary?
Dr. Carlson: This is the first ASCO guideline to specifically cover integrative therapies for anxiety And depression. People with cancer suffer from high levels of anxiety and depression throughout the course of the disease, and effective non-pharmacological treatments for these symptoms are needed. ASCO has published guidelines for screening, assessment, and conventional treatments for anxiety and depression in people with cancer, which have also been recently updated and are accessible here.
This more general article is considered a complementary guideline that complements the guideline on integrative therapies. While the general guidelines cover screening, assessment and conventional treatments for anxiety and depression, the integrative therapies guidelines focus specifically on the evidence supporting integrative therapies such as mindfulness meditation, yoga and acupuncture. (Painting).
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 time to review the current evidence and produce recommendations on the use of integrative therapies to treat symptoms of anxiety and depression in people with cancer across the cancer trajectory. of the disease.
PG: What are the most important findings from this assessment for physicians to understand?
Dr. Carlson: The guidelines’ strongest recommendation regarding symptoms of anxiety and depression is that physicians should offer mindfulness-based interventions (MBI) to cancer patients during and after active treatment.
MBIs are typically multi-week, group-based, in-person programs based on the Mindfulness-Based Stress Reduction Program. Jon Kabat-Zinn, Ph.D.. Participants are trained in mindfulness through daily practice of mindfulness meditation, discussing topics such as stress and the stress response, coping, attitudes of acceptance, non-judgment and compassion , as well as gentle and conscious movements through Hatha yoga practices. MBIs are increasingly offered as online programs and through digital applications.
The second strongest recommendation is yoga, which may be offered to people with cancer to reduce both anxiety and depression symptoms throughout the treatment journey. During cancer treatments, music therapy, relaxation therapies and reflexology may be offered to reduce symptoms of anxiety and depression in people with cancer. At the same time, hypnosis and inhalation of lavender essential oil can alleviate anxiety symptoms during diagnostic and treatment procedures.
Finally, tai chi or qigong programs can help relieve symptoms of depression and anxiety after treatment, and reflexology may be recommended for anxiety. Acupuncture may also be considered for women with breast cancer to reduce symptoms of anxiety after treatment.
PG: How can doctors incorporate these updated guidelines into their practice?
Dr. Carlson: Given that more than half of people with cancer use integrative therapies, healthcare professionals were in dire need of evidence-based guidelines to help them give sound advice on integrative therapies, both for improve outcomes for people who may benefit from these therapies and to avoid harm from unproven alternative treatments. There is additional helpful material, including treatment algorithms and summary tables, that healthcare professionals can use to make treatment recommendations and guide patients toward safe and effective integrative therapies. Healthcare professionals can also use them to advocate for the inclusion of these therapies in their treatment centers.
PG: 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 psychedelic-assisted therapy did not have enough evidence from randomized controlled clinical trials to make conclusive recommendations. That’s not to say they can’t be useful, but more research is needed. We also need more research on various types of cancer, on more advanced cancers, and on marginalized and racialized groups of people with cancer.
PG: What else do you think our readers should know about your research?
Dr. Carlson: Many patients suffer from debilitating anxiety and depression, which can be managed through various integrative therapies, as detailed in the recommendations. Clinicians are encouraged to refer to cancer centers and advocate for access, through publicly funded health care, to the many evidence-based therapies highlighted in these guidelines.
