ASCO/SIO Panel Recommends Mindfulness-Based Interventions to Manage Anxiety During Cancer Treatment

ASCO/SIO Panel Recommends Mindfulness-Based Interventions to Manage Anxiety During Cancer Treatment

Patients with cancer should be offered mindfulness-based interventions to manage symptoms of anxiety or depression related to treatment, according to updated guidelines by an expert panel comprised of Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) representatives.¹

The recommendation, which was published in the Journal of Clinical Oncology, is supported by an evidentiary body of 80 randomized controlled trials and 30 systematic reviews.

The panel defines mindfulness-based interventions as mindful stress reduction, mediation, and mindful movement. The recommendation to integrate these interventions into routine oncology care is strongly supported by the evidentiary body and is recommended across the board to help manage both anxiety and depression, at any stage in a cancer journey.

The guideline also included recommendations that were supported by a lower level of evidence. For example, for patients who are undergoing active treatment and experiencing symptoms of anxiety, the panel recommends yoga, relaxation, music therapy, reflexology, and aromatherapy. For patients who have completed active treatment but are still experiencing anxiety symptoms, the panel recommends yoga, acupuncture, tai chi and/or qigong, and reflexology.

Similarly, for patients who are undergoing active treatment and experiencing symptoms of depression, yoga, music therapy, relaxation, and reflexology are now recommended. For posttreatment symptoms of depression, yoga, and tai chi and/or qigong are recommended.

Read more: Lynda Balneaves, RN, PhD, provides insights into the new SIO/ASCO guidelines that support mindfulness-based interventions for patients with cancer.

“Anxiety and depression symptoms have long been associated with lower quality of life in people with cancer,” Heather Greenlee, ND, PhD, co-chair of the SIO Clinical Practice Guidelines committee, stated in a press release. “Treating these symptoms using evidence-based integrative therapies will not only improve a patient’s quality of life, but it can help them better manage their care too. Now we know which therapies could have the biggest impact.”²

Mental health concerns related to cancer continue to gain more attention as the advancement of therapeutics has increased the number of people living with—or having survived—their cancer diagnosis. It has been demonstrated that patients with cancer have a higher likelihood of developing a mental disorder within a 12-month span than the general population (OR, 1.28; 95% CI, 1.14-1.45).³ Further, a systemic review that evaluated 210 studies conclude that 21.2% of patients with cancer have clinical depression—regardless of disease type.⁴

SIO defines integrative oncology as a “patient-centered, evidence-informed field of cancer care that used mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments.” The intent behind integrative oncology is to optimize patient health and quality of life throughout treatment. Although these therapies are commonly referred to as complementary, the panel preferred to refer to them as integrative therapies in the guideline; to emphasize that, for optimal, patient-centered care, these practices should be fully integrated into routine oncology care.¹

The authors note that these therapies offer individuals the opportunity to feel in control over the impact of their illness and that they come with few, if any, adverse events. Many patients are already engaging in these integrative therapies, although rural environment and out-of-pocket costs may limit their uptake. According to a survey of 45 National Cancer Institute-designated cancer centers, acupuncture (73.3%), mediation and or yoga (68.9%, nutrition consultations (91.1%), dietary supplements (84.4%), and herbs (66.7%) are the integrative therapies most commonly offered today.

The panel concluded by noting that although the new guidelines are conservative in their recommendations, this does not mean that other integrative therapies are necessarily ineffective or unsafe, but rather that the supporting evidence is insufficient to make a formal recommendation at this time.

“For many people, cancer is the most difficult and frightening experience they have ever encountered,” Scott T. Tagawa, MD, MS, FASCO, FACP, added. “Mindfulness-based intervention and other mind-body therapies not only provide tools to manage patients’ anxiety and depression symptoms, but they can also offer patients a sense of control over their illness, which we know can be helpful for patients who have to navigate a complex treatment journey.”²

References

1. Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: society for integrative oncology-ASCO guideline. Published online August 15, 2023. J Clin Oncol. doi:10.1200/JCO.23.00857
2. Cancer organizations recommend mindfulness-based interventions to treat anxiety and depression in patients. Medical Xpress. News release. https://www.medicalxpress.com/views/
3. Vehling S, Mehnert-Theuerkauf A, Philipp R, et al. Prevalence of mental disorders in patients with cancer compared to matched controls - secondary analysis of two nationally representative surveys. Acta Oncol. 2022;61(1):7-13. doi:10.1080/0284186X.2021.1992008
4. Riedl D, Schuessler G. Prevalence of Depression and Cancer - A systematic review. Z Psychosom Med Psychother. 2022;68(1):74-86. doi:10.13109/zptm.2021.67.oa11