Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline

Abstract

1. •

   Anxiety and depressive disorders are common in patients with cancer.

2. •

   A higher prevalence seen in patients with cancer than the general population is often underrecognised.

3. •

   Psychotherapy, cognitive behavioural therapy and mindfulness-based therapies are effective treatments.

4. •

   Psychopharmacological treatments have been shown to be effective treatments of anxiety and depressive disorders.

Keywords: anxiety; cancer; depression; oncology; psychiatry; psycho-oncology.

Figure 1

Screening and management of anxiety symptoms/disorders. Purple: general categories or stratification; white: other aspects of management; turquoise: systemic therapy. AD, antidepressant; CBT, cognitive behavioural therapy; GAD, generalised anxiety disorder; MBT, mindfulness-based therapy; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor. ^aAt diagnosis, treatment, conclusion of treatment, recurrence and when relevant. ^bAnxious mood (feeling tense, worried), rumination about recurrence is disabling, sleep disturbance, agitation, difficulty in concentration. ^cAs appropriate.

Figure 2

Screening and management of depressive symptoms. Purple: general categories or stratification; white: other aspects of management; turquoise: systemic therapy. ACT, acceptance and commitment therapy; AD, antidepressant; BDI-II, Beck Depression Inventory, second edition; CALM, Managing Cancer and Living Meaningfully; CBSR, cognitive behavioural stress reduction; CBT, cognitive behavioural therapy; MBT, mindfulness-based therapy; PHQ-9, Patient Health Questionnaire-9; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor. ^aAt diagnosis, treatment, conclusion of treatment, recurrence and when relevant. ^bDepressed mood (feeling down, depressed, helpless/hopeless); anhedonia (little interest or pleasure in doing things). ^cAs appropriate.