A Multifaceted Approach to Managing Cancer-Related Anxiety and Depression

When addressing the psychological distress that often accompanies a cancer diagnosis, it is crucial for clinicians to consider a comprehensive toolkit that extends beyond conventional psychiatric medications.

While antidepressants and other pharmacological agents have a well-established role and are recommended by clinical guidelines, a truly holistic approach integrates a variety of evidence-based interventions. Boris M. Kiselev, MD, delves into the most effective methods for managing cancer-related anxiety and depression, highlighting the importance of psychotherapy as a foundational and lasting tool. He also discusses the significant benefits of integrative therapies and the critical need to address underlying medical conditions, offering a nuanced perspective on providing compassionate and effective care.

Kiselev is a consult liaison psychiatrist at Atrium Health Carolinas Medical Center, an assistant professor of the Psycho-Oncology Program in the Department of Supportive Oncology at Atrium Health Levine Cancer Institute, and an assistant professor in Internal Medicine.

Transcript:

[Many] times when people think about psycho-oncology, they’re thinking about antidepressants and what other things are out there. The idea that even though antidepressants are helpful and there’s a good evidence base to support their use for anxiety, depression, and cancer, and their use is recommended by guidelines, we still want to make sure we are using all the tools available to us. Psychology guidelines do recommend considering things like mindfulness-based interventions. This includes things like mindfulness-based stress reduction when that’s administered in a group or individual setting that has good, randomized trials supporting efficacy for anxiety and depression in patients dealing with cancer. There’s also good evidence for things like music therapy, relaxation interventions, for moderate quality evidence. There’s also good evidence for exercise being helpful for patients dealing with cancer, and that not only helps with both anxiety and depression, but also with sleep and fatigue. That’s supported by the American College of Sports Medicine Physical Activity Guidelines for adults dealing with cancer.

Additionally, there’s other integrative approaches too. You can consider things like Tai Chi, acupuncture, those all have lower quality evidence, but have been studied. Here at [Levine Cancer Institute], where I work, we have a robust integrative oncology department, and we’re often coordinating with them, referring patients to them, to get them connected with those types of treatment.

Other things to think about when managing these symptoms for patients, especially for those who are working in oncology is to make sure that we’re thinking about their medical comorbidities. For instance, thinking about patients who [receive] immunotherapy, considering endocrinopathies, it could be contributing to their psychiatric symptoms, or thinking about sleep disorders.

In terms of interventions, another thing I want to make sure I talk about as well is psychotherapy, and so the idea is that that’s going to help in many ways when we’re dealing with cancer, to process their experience. Talking about processing grief, learning tools and techniques can help them manage the symptoms day to day, develop coping skills, and help them to get just gain insight into themselves. The great thing about psychotherapy is that even after they complete the psychotherapy treatment that they’re doing, they’ll have those tools that they can take with them afterwards that will continue to be helpful to them in a longitudinal way.