Guidelines Define the Role of Integrative Oncology Care for Managing Anxiety and Depression in Adults With Cancer
By Lynda G. Balneaves, RN, PhD
One in five patients experiences (https://doi.org/10.13109/zptm.2021.67.oa11) anxiety or depression at some point during their cancer journey, and those with a concurrent mental health condition have (https://doi.org/10.1001/jamapsychiatry.2022.0347) an increased risk of death and shorter life span compared to the general population. Despite that stark reality, mental health conditions have been frequently undertreated in patients with cancer.
Integrative therapies, such as mind-body interventions, acupuncture, or natural products, may be one avenue that patients explore to cope and manage their mental health during the cancer journey. In 2023, the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) developed a joint clinical practice guideline (https://doi.org/10.1200/JCO.23.00857) on the role of integrative therapies in anxiety and depression management across the cancer trajectory.
Because research on integrative therapies in pediatric patients with cancer is limited, the guideline is restricted to adult patients. See the sidebar for an overview of the guideline’s key recommendations.
What the Evidence Says About Integrative Therapies for Anxiety and Depression
The quality of evidence and the strength of recommendation varied for the interventions. Mindfulness-based interventions, followed by yoga (particularly for people with breast cancer), had the highest quality evidence and strength of recommendation for both anxiety and depression (https://doi.org/10.1200/JCO.23.00857) during and post-treatment. In addition, hypnosis and relaxation therapies were also recommended (https://doi.org/10.1200/JCO.23.00857) as options to manage anxiety symptoms during and after treatment. Interestingly, the only integrative therapy not recommended (https://doi.org/10.1200/JCO.23.00857) was expressive writing for people experiencing depression throughout the cancer trajectory.
Numerous integrative therapies, such as natural products, dietary interventions, light therapy, psilocybin, massage, energy healing, and biofeedback, had either limited or poor-quality research that prevented SIO and ASCO from developing (https://doi.org/10.1200/JCO.23.00857) a clear recommendation for or against them. Further research should examine the efficacy and safety of these therapies, especially in people with diagnoses other than breast cancer, those with metastatic disease, and people from diverse backgrounds.
Implications for Oncology Nursing Practice
Oncology nurses should monitor people’s emotional well-being at each stage of the cancer trajectory and have an awareness of the integrative therapies that may be used with conventional care to manage anxiety and depression during and following treatment. Respecting people’s values, preferences, and comfort with integrative therapies can help nurses support individuals’ treatment decisions. Nurses should also assess patients for financial toxicity because many integrative therapies have significant out-of-pocket costs.
ONS’s symptom intervention guides for anxiety (https://www.ons.org/pep/anxiety) and depression (https://www.ons.org/pep/depression) were developed with an oncology nursing–specific lens on the evidence and recommend many of the same interventions. In the sidebar, click on the linked text for each intervention to read ONS’s recommendation.