Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline

Author: Linda E Carlson1, Nofisat Ismaila2, Elizabeth L Addington3, Gary N Asher4, Chloe Atreya5, Lynda G Balneaves6, Joke Bradt7, Nina Fuller-Shavel8, Joseph Goodman9, Caroline J Hoffman10, Alissa Huston11, Ashwin Mehta12, Channing J Paller13, Kimberly Richardson14, Dugald Seely15,16, Chelsea J Siwik17, Jennifer S Temel18, Julia H Rowland19
1 Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
2 American Society of Clinical Oncology, Alexandria, VA.
3 Northwestern University Feinberg School of Medicine, Chicago, IL.
4 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
5 University of California San Francisco, San Francisco, CA.
6 College of Nursing, University of Manitoba, Winnipeg, MB, Canada.
7 Department of Creative Arts Therapies, Drexel University, Philadelphia, PA.
8 Synthesis Clinic, Winchester, United Kingdom.
9 The George Washington University, Washington, DC.
10 Paul's Cancer Support, London, United Kingdom.
11 University of Rochester Medical Center, Rochester, NY.
12 Memorial Healthcare System, Hollywood, FL.
13 Sidney Kimmel Comprehensive Cancer Center, John Hopkins University, Baltimore, MD.
14 Patient Representative, University of Illinois Cancer Center, Chicago, IL.
15 University of Ottawa, Ottawa, ON, Canada.
16 Canadian College of Naturopathic Medicine, Toronto, ON, Canada.
17 Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA.
18 Massachusetts General Hospital and Harvard Medical School, Boston, MA.
19 Smith Center for Healing and the Arts, Washington, DC.
Conference/Journal: J Clin Oncol
Date published: 2023 Aug 15
Other: Special Notes: doi: 10.1200/JCO.23.00857. , Word Count: 283

To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer.

The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations.

The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline.

Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment.

Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at

PMID: 37582238 DOI: 10.1200/JCO.23.00857