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

...atment

...xiety...

...tive Treatme...

...1.1Mindfulness-based interventions (MBIs) s...

...commendation 1.2Yoga may be offered...

...ation 1.3Hypnosis may be offered to...

...mendation 1.4Relaxation therapies may be offered t...

...tion 1.5Music therapy or music-based interve...

...ommendation 1.6Reflexology may be offe...

...tion 1.7Lavender essential oil inhalation may b...

...-Treatment...

...dation 2.1Mindfulness-based interventions shoul...

....2Yoga may be offered to people with breast ca...

...endation 2.3Acupuncture may be offered t...

...mendation 2.4Tai chi and/or qigong may...

...2.5Reflexology may be offered to people wi...

...conclusive There is inconclusive evi...


...epressio...

Active Treatm...

...dation 3.1Mindfulness-based interventions should...

...3.2Yoga may be offered to people with breast canc...

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

...ecommendation 3.4Relaxation therapies ma...

...ommendation 3.5Reflexology may be offered to peo...

...-Treatment...

Recommendation 4.1Mindfulness-based intervention...

...ation 4.2Yoga may be offered to people with brea...

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

...mmendation 4.4Expressive writing shou...

...nclusiveThere is inconclusive evidence to make r...


...only Used Standardized Measuring Tools...


...igure 1. Integrative Therapies for Anxiety Sym...


...Integrative Therapies for Depression Sy...


Table 3. Interventio...

...e or acupressure...

...erapy...

...visual arts-based interventions)...

...hniques...

...otanicalsBotanicals are plants or a plant part us...

...al formulae...

...t therapy"Dance/movement therapy i...

...plements...

...ting, journaling, gratitudeIn expressive writing i...

...hter therapy...

...oting a state of consciousness inv...

...t therapyIntentional daily exposure to dir...

...utic massage and bodyworkTherapeutic massage and b...

...s-based interventions...

...Medita...

...lityPrograms in which a mix of modal...

...apy (music-based interventions) Music therap...

...or dietary approachesApproaches that utilize spe...

...s...

...sisted therapyThe use of psychedelic sub...

...eflexology is a gentle manipulatio...

...a Japanese form of hands-on heali...

...i and/or Qigong Qigong is a mind-body...

...or therapeutic touch...

...“Yoga is an anci...