Integrative Oncology Care of Symptoms of Anxiety and Depression in Adult Patients with Cancer

Publication Date: August 15, 2023

Key Points

Key Points

  • As cancer survivorship rates continue to rise, mental health concerns have become more prominent in the growing population of survivors.
  • The mean prevalence of clinical depression and anxiety is approximately 20% across all types of cancers.
  • Despite their ubiquity, psychological symptoms among people with cancer are often undertreated.

Table 1. Index of Terms

Depression
A mood disorder with 8 criteria, of which the individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. These symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Depressive symptoms
  • Depressed mood
  • Markedly diminished interest or pleasure in all, or almost all, activities
  • Significant weight loss when not dieting or weight gain or decrease or increase in appetite
  • A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down)
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Anxiety (generalized anxiety disorder)
The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive and very challenging to control. The anxiety and worry are accompanied with at least 3 of 6 physical or cognitive symptoms that include edginess or restlessness, impaired concentration and difficulty sleeping.

Anxiety symptoms
  • Excessive anxiety and worry (apprehensive expectation) about a number of events or activities (such as work or school performance)
  • The person finds it difficult to control the worry
  • The anxiety and worry are associated with 3 or more of the following 6 symptoms:
    • Restlessness or feeling keyed up or on edge
    • Being easily fatigued
    • Difficulty concentrating or mind going blank
    • Irritability
    • Muscle tension
    • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
Adjustment disorders with depressed anxious/ mood
Emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). With (1) low mood, tearfulness, or feelings of hopelessness or (2) anxiety, nervousness, worry, jitteriness, or separation anxiety in the presence of the major stressor and with significant impairment in social, occupational, or other important areas of functioning.

Post-traumatic stress (PTS) symptoms
  • Unwanted upsetting memories
  • Nightmares/night terrors
  • Flashbacks
  • Emotional distress; arousal after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders; hypervigilance
  • Avoidance of trauma-related stimuli after the trauma, in the following way(s):
    • Trauma-related thoughts or feelings
    • Trauma-related external reminders negative alterations in cognitions and mood
  • Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
    • Inability to recall key features of the trauma
    • Overly negative thoughts and assumptions about oneself or the world
    • Exaggerated blame of self or others for causing the trauma
    • Negative affect
    • Decreased interest in activities, feeling isolated
    • Difficulty experiencing positive affect
    • Alterations in arousal and reactivity
    • Trauma-related arousal and reactivity
Active treatment
After cancer diagnosis but before or during the course of surgery, chemotherapy, immunotherapy, or radiation therapy.

Post-treatment
After completion of surgery, chemotherapy or radiation therapy. Includes people on long-term maintenance therapies such as hormonal therapies (aromatase inhibitors, tamoxifen, androgen deprivation therapies).

Treatment

...Treatment...

...Anxiety...

...Active Treatment...

...ndation 1.1Mindfulness-based interve...

...mendation 1.2Yoga may be offered to...

....3Hypnosis may be offered to people wi...

...on 1.4Relaxation therapies may be offer...

...mmendation 1.5Music therapy or music-base...

....6Reflexology may be offered to peopl...

...1.7Lavender essential oil inhalation may be offe...

...Post-Treatment...

...mendation 2.1Mindfulness-based interventions...

...mendation 2.2Yoga may be offered to people with br...

...ion 2.3Acupuncture may be offered to women...

...ion 2.4Tai chi and/or qigong may be offered to w...

...endation 2.5Reflexology may be offered to...

...here is inconclusive evidence to make recommen...


...Depression...

...Activ...

...tion 3.1Mindfulness-based interventions shoul...

...dation 3.2Yoga may be offered to people with br...

...ommendation 3.3Music therapy or music-based...

...3.4Relaxation therapies may be offered to people...

...ecommendation 3.5Reflexology may b...

...Post-Treatment...

...ndation 4.1Mindfulness-based interventi...

...4.2Yoga may be offered to people...

...4.3Tai chi-qigong may be offered to p...

...mmendation 4.4Expressive writing should not be o...

...siveThere is inconclusive evidence to ma...


Table 2....


...tegrative Therapies for Anxiety Sympt...


...igure 2. Integrative Therapies for Depressi...


...Table 3....

...Acupun...

...AromatherapyAromatherapy...

...Art therapy (visual arts-...

...Relax...

...anicals are plants or a plant part used for it...

...Chinese herbal formu...

...ance/movement therapy"Dance/movemen...

...Dietary...

...ssive writing, journaling, gratitudeIn expres...

...Humor or...

...ing a state of consciousness involvi...

Light therapyIntentional daily exposu...

...ic massage and bodyworkTherapeutic massage and bo...

...Mindfulness-based interven...

...MeditationMeditation is...

Multi-modalityPrograms in which a mix of modalitie...

...y (music-based interventions) Music...

...itional or dietary approachesAppro...

...Pr...

...chedelic-assisted therapyThe use of psych...

...Reflexology is a gentle manipulation or pre...

...eiki is a Japanese form of hands-on heal...

...Qigong Qigong is a mind-body prac...

...Healing touch or thera...

...Yoga...