Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update
Open accessAbstract
PURPOSETo update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors.METHODSA multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted.RESULTSThe evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations.RECOMMENDATIONSIt is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines. © American Society of Clinical Oncology.
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Claims the paper makes
60 of 157 cited sources checked · 16 supported · 3 flagged · accuracy not yet measured
- Findingcitation
Neither of these trials included participants above a threshold for depressive symptoms.
“However, neither of these trials included participants above a threshold for depressive symptoms.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [103] source
The Methods (Measures; page unavailable) define a depression-score threshold of >1.0. The Methods (Procedure) say participants with impaired depression scores were included and randomized, and the Results report outcomes for participants with impaired depression scores at baseline. Thus, the claim is contrary to what this cited trial reports; this paper does not establish anything about the other trial. (LLM, conf=0.91)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured - cites [72] source
- Premisecitation
The risk for self-harm and/or suicide is 85% higher (SMR 1.85; 95% CI, 1.55 to 2.20) in cancer patients than in the general population.
“The risk for self-harm and/or suicide has been reported to be 85% higher (standardized mortality ratio, 1.85; 95% CI, 1.55 to 2.20) than for the general population, 39 with the greatest risk during the first 12 months after cancer diagnosis, 40,41 underscoring the importance of screening for the newly diagnosed.42,43”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [39] source
The Results (p. 2) report an 85% higher suicide mortality rate among patients with cancer than in the general population, with the stated SMR and confidence interval. The paper's estimate concerns deaths by suicide, not the broader outcome of self-harm and/or suicide. (LLM, conf=0.87)
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Elevated anxiety possibly predicts cancer recurrence.
“Elevated anxiety predicts nonadherence to recommended therapies, [23][24][25] higher use and costs of medical care, [26][27][28] and possibly cancer recurrence.29”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [29] source
The Discussion says anxiety can predict recurrence, and the results report a pooled hazard ratio of 1.17 (95% CI 1.02–1.34). The evidence is limited to patients with breast cancer; the citing sentence does not specify that population. (LLM, conf=0.82)
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The greatest risk for self-harm and/or suicide is during the first 12 months after cancer diagnosis.
“The risk for self-harm and/or suicide has been reported to be 85% higher (standardized mortality ratio, 1.85; 95% CI, 1.55 to 2.20) than for the general population, 39 with the greatest risk during the first 12 months after cancer diagnosis, 40,41 underscoring the importance of screening for the newly diagnosed.42,43”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [40] source
The Discussion (page unavailable) reports that another study found significantly higher suicide risk within the first year after cancer diagnosis. But this paper’s finding that self-harm risk was highest within 12 months is measured from mental-health diagnosis, not cancer diagnosis. It therefore does not establish that the combined risk of self-harm and/or suicide is greatest in the first 12 months after cancer diagnosis. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [41] source
The Results section identifies the first 6 months after cancer diagnosis—not the first 12 months—as the period with the greatest suicide risk. The paper's findings concern suicide; its discussion mentions self-harm events but does not establish when self-harm risk is greatest. (LLM, conf=0.88)
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Depression at diagnosis and throughout the cancer trajectory covaries with impaired immunity.
“Depression at diagnosis and throughout the cancer trajectory 16 covaries with lower adherence to treatment and follow-up care, increased inflammation, impaired immunity, and reduced survival.17,18”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [16] source
The Discussion describes prior breast-cancer research that tracked depressive symptoms and measures of immunity from diagnosis over five years. It does not say that depression covaried with impaired immunity, and this paper's own analysis examined depressive-symptom trajectories and survival rather than immune function. (LLM, conf=0.83)
Experimental — accuracy not yet measured - cites [17] source
- cites [18] source
The Discussion (page unavailable) names immunological activity as a possible common factor in depression and worse cancer survival. It does not report that depression covaries with impaired immunity, and its limitations state that the time-course of depression was unavailable, so it cannot support the claim about the entire cancer trajectory. (LLM, conf=0.83)
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Using self-report instruments with specified cutoff points, moderate to severe depressive symptom rates between 13% and 27% have been reported.
“Using self-report instruments with specified cutoff points (eg, Patient Health Questionnaire-9 $ 10), moderate to severe depressive symptom rates between 13% and 27% have been reported.[32][33][34][35]”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [32] source
- cites [33] source
The Measures section (p. 3) describes a self-administered HADS questionnaire with a depression cutoff of ≥8, and the prevalence results (p. 4) report 13% depression caseness at both time points. This source does not report a 27% rate or characterize its cutoff-defined cases as moderate to severe; it used HADS, not the PHQ-9 given as an example in the citing sentence. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [34] source
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Elevated anxiety predicts nonadherence to recommended therapies.
“Elevated anxiety predicts nonadherence to recommended therapies, [23][24][25] higher use and costs of medical care, [26][27][28] and possibly cancer recurrence.29”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [23] source
The Results report that heightened anxiety at diagnosis predicted a greater likelihood of chemotherapy dose delay or reduction over the next six months in patients with advanced NSCLC. The Discussion likewise identifies elevated anxiety as a predictor of poor chemotherapy adherence, but this does not establish nonadherence to recommended therapies generally. (LLM, conf=0.86)
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Depression at diagnosis and throughout the cancer trajectory covaries with lower adherence to treatment and follow-up care.
“Depression at diagnosis and throughout the cancer trajectory 16 covaries with lower adherence to treatment and follow-up care, increased inflammation, impaired immunity, and reduced survival.17,18”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [16] source
The Abstract reports an association between depressive-symptom trajectories and survival in patients with advanced non–small cell lung cancer, not an association with treatment or follow-up adherence. Searches for adherence, compliance, and missed follow-up care found no passage addressing the claimed relationship; the paper’s reference to compliance concerns completion of study assessments. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [17] source
- cites [18] source
The Discussion (page unavailable) suggests that depression might reduce adherence to anticancer treatment, but presents this as a possible explanation for its association with worse survival, not an established finding. It does not report an association with adherence to follow-up care or assess depression throughout the cancer trajectory. (LLM, conf=0.87)
Experimental — accuracy not yet measured
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Elevated anxiety predicts higher use and costs of medical care.
“Elevated anxiety predicts nonadherence to recommended therapies, [23][24][25] higher use and costs of medical care, [26][27][28] and possibly cancer recurrence.29”
Quote in the paperNot a substantial claim1 of 3 sources checked - Premisecitation
In the short term, stress covaries with depressive and anxiety symptoms, negative quality of life, physical symptoms, and treatment morbidities across patients.
“In the short term, stress covaries with depressive and anxiety symptoms, negative quality of life, physical symptoms, and treatment morbidities across patients, [10][11][12]”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [10] source
The Results (‘Intrusive Thoughts as a Predictor of Symptoms Over Time’; page unavailable) report that women with more cancer-related intrusive thoughts had worse depressive, physical-symptom, and quality-of-life outcomes at baseline. The study examined women shortly after breast cancer treatment, not patients generally; it did not report a separate association with anxiety symptoms or specifically assess treatment morbidities. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [11] source
The Results report that stress was associated with poorer psychological quality of life at the initial assessment and predicted poorer psychological and physical quality of life at four months; the Discussion notes that stress was not correlated with physical quality of life at diagnosis or surgery. The study followed women with breast cancer and did not separately establish associations with depressive and anxiety symptoms, physical symptoms, or treatment morbidities across patients generally. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [12] source
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In the long term, stress is related to cancer mortality.
“in the long term, data show its relationship to cancer mortality.13”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [13] source
The Introduction describes allostatic load as physiological wear and tear from accumulated stress and reports an association between high allostatic load and cancer-specific mortality. The Results (Overall Mortality; page unavailable) find higher allostatic load associated with overall mortality in patients with metastatic non–small cell lung cancer, but do not establish a long-term association between directly measured stress and cancer-specific mortality in general. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Depression at diagnosis and throughout the cancer trajectory covaries with increased inflammation.
“Depression at diagnosis and throughout the cancer trajectory 16 covaries with lower adherence to treatment and follow-up care, increased inflammation, impaired immunity, and reduced survival.17,18”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [16] source
The Discussion says depression has inflammation-inducing effects and describes depression at diagnosis and its persistence in patients with advanced lung cancer. But it calls for studies combining depression and inflammation measures; this paper does not establish that the two covary at diagnosis or throughout the cancer trajectory. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [17] source
- cites [18] source
The Discussion names inflammation as a possible common factor in depression and worse cancer survival, but does not establish that depression covaries with increased inflammation. It also says the study lacked information on the time course of depression, so it cannot support the claim across the cancer trajectory. No page number was provided for these passages. (LLM, conf=0.83)
Experimental — accuracy not yet measured
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Depression at diagnosis and throughout the cancer trajectory covaries with reduced survival.
“Depression at diagnosis and throughout the cancer trajectory 16 covaries with lower adherence to treatment and follow-up care, increased inflammation, impaired immunity, and reduced survival.17,18”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [16] source
- cites [17] source
- cites [18] source
The Discussion reports worse subsequent survival among patients with major depression than among those without it. But the study assessed depression at varying intervals after cancer diagnosis and lacked information on its time course, so it does not establish the association specifically at diagnosis or throughout the cancer trajectory. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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Meta-analyses confirm that when delivered to adults without cancer, CBT in particular, behavior therapy, and behavioral activation are the most efficacious treatments for treating major depressive disorder.
“Meta-analyses 54,60,61 confirm findings from many prior ones 120-122 that when delivered to adults without cancer, CBT in particular, behavior therapy (BT), and BA are the most efficacious treatments for treating MDD.”
Quote in the paperNot a substantial claim4 of 6 sources checked- cites [54] source
The Discussion (page not provided) reports that CBT reduced depression scores more than treatment as usual in adults. It does not establish that CBT, behavior therapy, and behavioral activation are the most efficacious treatments: the analysis focuses on CBT interventions, finds no strong evidence for specific components, and does not rank those three therapies against other treatments. (LLM, conf=0.89)
Experimental — accuracy not yet measured - cites [60] Uphoff E, 2020, Cochrane Database Syst Rev source
The ‘Agreements and disagreements with other studies or reviews’ section reports that behavioural activation may be more effective than some comparators and no less effective than CBT. It does not establish that CBT, behavioural therapy and behavioural activation are the most efficacious treatments for adults without cancer. The review’s own meta-analysis included a breast-cancer study and a poststroke study, and its ‘Implications for practice’ section says the evidence is insufficient for clinical conclusions. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [61] source
- cites [120] source
Section 2.1 (Depression; page unavailable) reports that CBT outperformed wait-list or placebo controls and was statistically equivalent to behavior therapy in clinical and non-clinical depression samples. The review does not establish that these are the most efficacious treatments overall: it reports only marginal superiority of CBT over other bona fide therapies and does not address behavioral activation separately. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [121] source
The Effects of CBT on MDD section reports that CBT, including behavioral activation trials, was effective compared with control conditions. But the Discussion describes the effects as uncertain and does not establish that CBT, behavior therapy, and behavioral activation are the most efficacious treatments relative to other therapies. The Identification and selection of studies section did not exclude people with somatic disorders, so this analysis does not specifically establish the claim for adults without cancer. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [122] source
- Premisecitation
Two additional RCTs not already included in the systematic reviews reported a statistically significant reduction in both depression and anxiety with physical activity interventions compared with control with no physical activity intervention.
“Two additional RCTs not already included in the systematic reviews reported a statistically significant reduction in both depression and anxiety with PA interventions compared with control with no PA intervention.71,95”
Quote in the paperNot a substantial claim2 of 2 sources checked - Findingcitation
Head-to-head comparisons of selective serotonin reuptake inhibitors versus tricyclic antidepressants showed no difference.
“Also, head-to-head comparisons of selective serotonin reuptake inhibitors versus tricyclic antidepressants showed no difference.57”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev source
- Premisecitation
Other meta-analyses support the benefit of exercise for depression.
“While evidence from other meta-analyses support the benefit of exercise for depression, no significant benefit was found for anxiety.47,49”
Quote in the paperNot a substantial claim1 of 2 sources checked - Findingcitation
Interventions for managing anxiety disorders or anxiety symptoms were evaluated in only three RCTs identified in the updated literature search.
“Interventions for managing anxiety disorders or anxiety symptoms were evaluated in only three RCTs identified in the updated literature search.73,76,85”
Quote in the paperSubstantial claim1 of 3 sources checked - Findingcitation
A 2018 Cochrane review of antidepressant use in cancer patients with MDD found no difference between antidepressants (as a class) and placebo on symptoms of depression at 6-12 weeks.
“Pharmacologic management was investigated in a 2018 Cochrane review of antidepressant use in cancer patients with MDD and no difference between antidepressants (as a class) and placebo on symptoms of depression at 6-12 weeks was found.57”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev source
The Main results report no difference between antidepressants as a class and placebo on depressive symptoms at 6–12 weeks, based on very-low-certainty evidence. But the Types of participants section includes people with adjustment disorder, dysthymia, or depressive symptoms without a formal major-depression diagnosis, as well as those with MDD. The cited result therefore is not specific to cancer patients with MDD. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Findingcitation
The Cochrane review concluded that the evidence for medications compared with placebo was of low certainty based on the limited number and low quality of studies.
“The Cochrane review concluded that the evidence for medications compared with placebo was of low certainty based on the limited number and low quality of studies.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev source
The Quality of the evidence section attributes uncertainty to poor study quality, high risk of bias, and small trials, supporting the stated reasons. But it rates confidence in all main outcomes as “very low,” not “low”; the Certainty of the evidence section also uses “very low.” (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Findingcitation
The other trial with unscreened patients found reductions in depressive symptoms with individual supportive psychotherapy compared with TAU.
“The other trial 93 with unscreened patients found reductions in depressive symptoms with individual supportive psychotherapy compared with TAU.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [93] source
- Premisecitation
Other meta-analyses found no significant benefit of exercise for anxiety.
“While evidence from other meta-analyses support the benefit of exercise for depression, no significant benefit was found for anxiety.47,49”
Quote in the paperNot a substantial claim1 of 2 sources checked - Findingcitation
One RCT evaluating a combined physical exercise and healthy eating treatment versus usual care for post-treatment female breast cancer patients demonstrated a significant effect on depression at 6 months.
“One RCT evaluating a combined physical exercise and healthy eating treatment versus usual care for post-treatment female breast cancer patients demonstrated a significant effect on depression at 6 months.96”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [96] source
- Findingcitation
A systematic review of 21 studies showed CBT and other interventions, when delivered either face-to-face or by telephone, to improve anxiety and depression in patients with cancer.
“A systematic review of 21 studies showed CBT and other interventions, when delivered either face-to-face or by telephone, to improve anxiety and depression in patients with cancer.58”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [58] Ream E, 2020, Cochrane Database Syst Rev source
The Discussion (Summary of main results; page not provided) says the review included 32 studies, not 21; 21 assessed depressive symptoms and 16 assessed anxiety. The outcomes sections report some improvements, including equivalent anxiety and depression outcomes for telephone and face-to-face CBT in one trial, but also studies with no significant benefit. The claim overstates these mixed findings as a result of the review’s interventions generally. (LLM, conf=0.91)
Experimental — accuracy not yet measured
- Premisecitation
One meta-analysis reported that mindfulness-based interventions were associated with a reduction in the severity of depression and anxiety in both the short term and medium term, but not in the long term.
“One of these meta-analyses reported that mindfulness-based interventions were associated with a reduction in the severity of depression and anxiety in both the short term and medium term, but not in the long term.56”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [56] source
The Discussion reports short- and medium-term reductions in anxiety and depression, but not long-term reductions. The claim omits the study’s population qualifier: these findings concern adults with cancer, not people generally. (LLM, conf=0.86)
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One third of patients report experiencing significant psychological distress during the period between diagnosis and start of treatment.
“The period between diagnosis and start of treatment is an essential time for first screening, as one third of patients report experiencing significant psychological distress during this period.35”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [35] source
The Discussion reports that 33% of patients with early breast cancer had depression, anxiety, or both at diagnosis. That supports an approximately one-third figure at diagnosis, but not the claim that one-third of cancer patients experience significant psychological distress throughout the interval before treatment. The Results measure depression in the acute phase, not distress specifically during that interval. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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The 2018 Cochrane review found null findings for antidepressant use for MDD in patients with cancer at 6-12 weeks.
“a conclusion informed by the 2018 Cochrane review of null findings for antidepressant use for MDD in patients with cancer at 6-12 weeks, a sufficient interval in pharmacologic trials for effects to be detected.57”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev source
- Premisecitation
Survivors who are Black consistently report poorer quality of life and physical and mental health compared with cancer survivors who are White, found in studies of breast, prostate, or colorectal cancer.
“Survivors who are Black consistently report poorer quality of life and physical and mental health compared with cancer survivors who are White, found in studies of breast, prostate, or colorectal cancer.[153][154][155][156][157]”
Quote in the paperNot a substantial claim1 of 5 sources checked- cites [153] American Association for Cancer Research, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [154] source
The Methods (Participants) and Discussion describe comparisons among African-American women with breast cancer, other cancers, or no cancer—not comparisons with White survivors. The Introduction mentions Black–White differences in breast cancer survival and mortality, but our copy does not address the claimed racial differences in quality of life or physical and mental health across breast, prostate, and colorectal cancer. (LLM, conf=0.76)
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- cites [156] source
- cites [157] source
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Cancer survivors who identify as sexual minorities have two to three times greater risk for depression and/or poor mental health compared with heterosexual counterparts among all races.
“In addition to racial and ethnic minorities, cancer survivors who identify as sexual minorities have two to three times greater risk for depression and/or poor mental health compared with heterosexual counterparts among all races.153,[158][159][160][161][162][163]”
Quote in the paperNot a substantial claim2 of 7 sources checked- cites [153] American Association for Cancer Research, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [158] source
- cites [159] source
- cites [160] source
The Health-related quality of life results (page unavailable) report higher odds of severe psychological distress for bisexual women cancer survivors than for heterosexual women (OR 3.03). The Discussion says lesbian survivors did not show a disparity in psychological distress. The study concerns women and does not establish the claimed difference among all races or measure depression specifically. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [161] Schefter A, 2022, Cancer Rep source
The Introduction estimates mental-health disorders to be 2–3 times more common among sexual-minority people than in the general population, not specifically among cancer survivors. The Results report depression symptoms in 31.8% of LGB versus 10.6% of heterosexual gynecologic cancer survivors, but do not establish that this difference holds among all races; the sample was predominantly non-Hispanic white. (LLM, conf=0.89)
Experimental — accuracy not yet measured - cites [162] source
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Some trials with positive effects on other dimensions were also found to effectively treat adults with depression.
“Even so, some trials with positive effects on other dimensions (ie, where anxiety or depression were not among the primary outcomes) were also found to effectively treat adults with depression.137,138”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [137] source
The Measures and Evaluations section (p. 2) identifies anxiety/depression as a secondary outcome, and the Results (p. 1) report significantly lower levels in the intervention group after treatment. But the trial enrolled cancer survivors reporting cognitive symptoms, not adults identified as having depression, and measured anxiety/depression together. It therefore does not establish that the program effectively treated depression in adults with depression. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [138] source
The Results (Table 3) show that, after a pain-focused intervention, the proportion of outpatients with advanced solid tumors scoring ≥11 for depression fell from 73% to 51% at one week. The Statistical analysis section identifies pain reduction—not depression—as the primary endpoint. But the Results (Table 4) found no additional depression benefit from telemonitoring over pain education alone, so the study does not establish that the intervention effectively treated depression compared with no intervention. (LLM, conf=0.85)
Experimental — accuracy not yet measured
- Findingown data
Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety in adult cancer survivors.
“Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety.”
Quote in the paperSubstantial claim - Findingnone given
Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent.
“Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent.”
Quote in the paperSubstantial claim - Findingnone given
The lack of inclusion of survivors from minoritized groups in the evidence base was noted and identified as an important consideration for providing high-quality care for ethnic minority populations.
“The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations.”
Quote in the paperNot a substantial claim - Findingown data
The evidence base for this guideline update consisted of 17 systematic reviews, 6 meta-analyses, and 44 randomized controlled trials.
“The evidence base consisted of 17 systematic reviews 6 meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials.”
Quote in the paperNot a substantial claim - Findingnone given
Current evidence supports that the recommended treatment interventions for depression and anxiety are effective therapeutic options.
“Current evidence supports that the recommended treatment interventions for depression and anxiety are effective therapeutic options.”
Quote in the paperNot a substantial claim - Findingcitation
CBT was found to be superior to bright light therapy.
“CBT was also found to be superior to bright light therapy.74”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [74] source
- Findingown data
10 studies focused on patients with advanced cancer and/or in palliative care.
“A total of 10 studies 50,76,80,81,89,93,98,102,104,107 focused on patients with advanced cancer and/or in palliative care.”
Quote in the paperNot a substantial claim - Findingcitation
Despite inclusion of only randomized trials, randomization failed to establish baseline equivalence in 36% of the studies.
“Despite inclusion of only randomized trials, randomization failed to establish baseline equivalence in 36% of the studies.67,68,73,[75][76][77]79,80,82,88,91,99,103,105”
Quote in the paperNot a substantial claim - Findingown data
For systematic reviews and meta-analyses, assessment of multiple systematic reviews scores ranged from 8 to 11 out of a possible 11 points.
“For systematic reviews and meta-analyses, assessment of multiple systematic reviews scores ranged from 8 to 11 out of a possible 11 points (higher scores indicate higher quality; Data Supplement).”
Quote in the paperNot a substantial claim - Findingown data
Very few trials were identified for management of post-traumatic stress disorder in cancer populations for this update.
“Although the Expert Panel also sought to evaluate the evidence for management of post-traumatic stress disorder in cancer populations for this update, very few trials were identified (Data Supplement, online only).”
Quote in the paperSubstantial claim - Findingown data
The included studies used a variety of psychological interventions including CBT, information, counseling, education, problem-solving therapy, behavioral activation, psychotherapy, physical activity, and pharmacologic interventions.
“The included studies used a variety of psychological interventions including, either alone or in combination, cognitive behavior therapy (CBT), information, counseling, education, problem-solving therapy, behavioral activation (BA), psychotherapy, PA, and pharmacologic interventions (Table 2).”
Quote in the paperNot a substantial claim - Findingown data
18 systematic reviews and 48 RCTs met initial eligibility criteria that included post-traumatic stress disorder.
“A total of 18 systematic reviews with or without meta analyses [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] and 48 RCTs, one with dual publication, 100,101 met initial eligibility criteria that included post-traumatic stress disorder.”
Quote in the paperNot a substantial claim - Findingnone given
In studies with high-quality ratings, RCT evidence supports the benefit of CBT.
“In studies with high-quality ratings, RCT evidence supports the benefit of CBT.”
Quote in the paperSubstantial claim - Findingcitation
For the nonpharmacologic RCTs (39 studies), only four (10%) trials had low risk of bias across all domains.
“For the nonpharmacologic RCTs (39 studies), only four (10%) trials had low risk of bias across all domains.96,97,104,107”
Quote in the paperSubstantial claim - Findingown data
17 studies (28%) did not restrict participation to a particular phase of the cancer continuum and included participants both during and after oncologic treatment.
“A total of 17 studies (28%) did not restrict participation to a particular phase of the cancer continuum and included participants both during and after oncologic treatment.”
Quote in the paperNot a substantial claim - Findingown data
16 meta-analyses, 1 systematic review, and 44 RCTs on management of anxiety and/or depression formed the updated evidentiary base for the guideline recommendations.
“Sixteemeta-analyses, [47][48][49][50][52][53][54][55][56][57][59][60][61][62][63][64] one systematic review, 58 and 44 RCTs 93,[95][96][97][98][99][100][101][102][103][104][105][106][107][108][109] on management of anxiety and/or depression ultimately formed the updated evidentiary base for the guideline recommendations.”
Quote in the paperSubstantial claim - Findingown data
The most common domain of high-risk bias, found in 53% of RCTs, was missing data from attrition due to drop out, loss to follow-up, or patients continuing in the trial but missing assessments for other causes.
“Indeed, the most common domain of high-risk bias, found in 53% of RCTs, was missing data from attrition due to drop out, loss to follow-up, or patients continuing in the trial but missing assessments for other causes (eg, illness, administrative error, etc).”
Quote in the paperNot a substantial claim - Findingnone given
Most non-US studies did not provide ethnic and/or racial characteristics of the participants.
“Most non-US studies did not provide ethnic and/or racial characteristics of the participants.”
Quote in the paperNot a substantial claim - Findingown data
For the 55 nonpharmacologic studies, the intervention arm was most often compared with a treatment-as-usual control (36 studies).
“For the 55 nonpharmacologic studies, the intervention arm was most often compared with a treatment-as-usual (TAU) control (36 studies).”
Quote in the paperNot a substantial claim - Findingown data
For RCTs, overall risk of bias ranged from low to high.
“For RCTs, overall risk of bias ranged from low to high (Data Supplement).”
Quote in the paperNot a substantial claim - Findingnone given
In studies using screening, all patients were described as being in the postoncologic treatment phase.
“In studies using screening, all patients were described as being in the postoncologic treatment phase.”
Quote in the paperNot a substantial claim - Findingcitation
A less intensive intervention, that is, a collaborative care coordinator and a patient accessed web site providing CBT components, did not produce a significant improvement in depression compared with enhanced usual care for unscreened patients with advanced cancer.
“A less intensive intervention, that is, a collaborative care coordinator and a patient accessed web site providing CBT components, did not produce a significant improvement in depression compared with enhanced usual care for unscreened patients with advanced cancer.102”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [102] source
- Findingcitation
The effectiveness of collaborative care approaches in the treatment of depression in screened patients with cancer was found in two of three trials.
“The effectiveness of collaborative care approaches in the treatment of depression in screened patients with cancer was found in two 99,107 of three trials.99,102,107”
Quote in the paperSubstantial claim0 of 3 sources checked - Findingcitation
Two RCTs, not included in the Cochrane review, investigated the effect of celecoxib on depression at 4 and 6 weeks in patients with cancer.
“Two RCTs, not included in the Cochrane review, investigated the effect of celecoxib, a nonsteroidal antiinflammatory drug that acts via the selective inhibition of cyclooxygenase (COX)-2, on depression at 4 and 6 weeks in patients with cancer.66,86”
Quote in the paperNot a substantial claim0 of 2 sources checked - Findingcitation
This early antidepressant response in terminally ill patients with cancer was associated with an increased risk of nervous system adverse events.
“However, this early antidepressant response in terminally ill patients with cancer was associated with an increased risk of nervous system adverse events.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [89] source
- Findingnone given
Comparative effectiveness studies indicated similar effects across different models of psychological interventions.
“Comparative effectiveness studies indicated similar effects across different models of psychological interventions.”
Quote in the paperSubstantial claim - Findingcitation
A group intervention combining CBT, hypnosis, and support yielded significantly reduced anxiety compared with standard care enhanced with support for female breast cancer survivors.
“A group intervention combining CBT, hypnosis, and support yielded significantly reduced anxiety compared with standard care enhanced with support for female breast cancer survivors.85”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [85] source
- Findingcitation
This was also the case if additional therapies were included, such as second-wave therapies (MBSR, acceptance, and commitment therapy).
“This was also the case if additional therapies were included, such as second-wave therapies (MBSR, acceptance, and commitment therapy).50”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] source
- Findingnone given
Many studies (one third) began with baseline group differences.
“many studies (one third) began with baseline group differences”
Quote in the paperNot a substantial claim - Findingnone given
Excluding studies of education only, many of the remaining trials are single examples of experimenter-developed treatments.
“Excluding the studies of education only, many of the remaining trials are single examples of experimenterdeveloped treatments.”
Quote in the paperNot a substantial claim - Findingnone given
Patients with major depression were more often excluded from trial participation.
“patients with the latter were more often excluded from trial participation.”
Quote in the paperNot a substantial claim - Findingnone given
Psychological screening for trial entry was rare in the reviewed trials.
“Psychological screening for trial entry was rare”
Quote in the paperNot a substantial claim - Findingreasoning
95% of the reviewed studies focused on depression alone or with comorbid anxiety.
“95% of the reviewed studies focused on depression alone or with comorbid anxiety.”
Quote in the paperSubstantial claim - Findingcitation
The Ren study showed significant effects for CBT compared with both attention control and TAU arms.
“The Ren study 91 is notable for showing significant effects for CBT in comparison with both attention control and TAU arms.”
Quote in the paperNot a substantial claim - Findingreasoning
The majority of study participants (60%-70%) likely had no or few symptoms of generalized anxiety or major depression.
“with the majority of study participants (60%-70%) likely having no or few symptoms of generalized anxiety or major depression”
Quote in the paperNot a substantial claim - Findingreasoning
Evidence is confirmatory for multiple modes of delivery including by app, virtually, telephone, and others.
“Relevant to cost of treatment, evidence is also confirmatory for multiple modes of delivery including by app, virtually, telephone, and others.”
Quote in the paperNot a substantial claim - Findingown data
Posttreatment follow-up data were provided in eight studies (36%) to test for sustained effects of interventions.
“posttreatment follow-up data were provided in eight studies (36%) to test for sustained effects of interventions.”
Quote in the paperNot a substantial claim - Findingnone given
Three RCTs were conducted in palliative care settings or with palliative care specialists.
“Three RCTs were conducted in palliative care settings or with palliative care specialists.”
Quote in the paperNot a substantial claim - Findingcitation
In the Lepore noninferiority trial, analyses showed worsened outcomes for those in the enhanced support group.
“Analyses showed worsened outcomes for those in the enhanced condition.”
Quote in the paperSubstantial claim - Findingown data
Evidence for pharmacotherapies is limited and low-quality.
“This contrasts with the limited, low-quality evidence for pharmacotherapies.”
Quote in the paperSubstantial claim - Findingreasoning
There is no evidence from RCTs to suggest that educational sessions about radiotherapy impact anxiety or depressive symptoms.
“there is no evidence from RCTs to suggest such efforts would impact anxiety or depressive symptoms.”
Quote in the paperNot a substantial claim - Findingown data
The majority of CBT and BT trials showed significant effects for depression.
“Consistent with the meta-analyses, all trials of CBT 75,88,90,91 and BT (ie, problem solving) 67 showed significant effects on anxiety with the majority showing significant effects for depression as well.”
Quote in the paperSubstantial claim - Findingown data
In the systematic review, statistically significant benefits were seen for various management strategies across comorbid depression and anxiety symptoms.
“Statistically significant benefits were seen for various management strategies across the comorbid symptoms.”
Quote in the paperSubstantial claim - Findingown data
Screening was used in only one third of studies.
“In RCTs, screening of patients is essential (used in only one third of studies) and has the potential benefit of reducing sample size.”
Quote in the paperNot a substantial claim - Findingcitation
All trials of CBT and BT showed significant effects on anxiety.
“Consistent with the meta-analyses, all trials of CBT 75,88,90,91 and BT (ie, problem solving) 67 showed significant effects on anxiety with the majority showing significant effects for depression as well.”
Quote in the paperSubstantial claim - Findingreasoning
Other than palliative care, the most common source of bias in the RCTs was attrition.
“Other than the latter, the most common source of bias in the RCTs was attrition.”
Quote in the paperNot a substantial claim - Findingcitation
The Hoek trial found null effects on depressive symptoms.
“All treatments were successful in significantly reducing anxiety and depressive symptoms, with the exception of the Hoek trial, 80 which found null effects on depressive symptoms.”
Quote in the paperNot a substantial claim - Premisecitation
In comparison with a control group, depression prevalence rates among people with cancer are at least two times higher for major depression (OR, 2.07; 95% CI, 1.71 to 2.51).
“In comparison with a control group, depression prevalence rates among people with cancer are at least two times higher for unipolar mood disorders (major depression: OR, 2.07; 95% CI, 1.71 to 2.51; dysthymia: OR, 2.93; 95% CI, 2.13 to 4.02).4”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4] source
- Premisecitation
In comparison with a control group, depression prevalence rates among people with cancer are at least two times higher for dysthymia (OR, 2.93; 95% CI, 2.13 to 4.02).
“In comparison with a control group, depression prevalence rates among people with cancer are at least two times higher for unipolar mood disorders (major depression: OR, 2.07; 95% CI, 1.71 to 2.51; dysthymia: OR, 2.93; 95% CI, 2.13 to 4.02).4”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4] source
- Premisecitation
Stepped collaborative care interventions have been used in the primary care setting for the treatment of depression, where a combination of pharmacologic and psychological treatments are customized based on the severity of depression.
“Stepped collaborative care interventions have been used in the primary care setting for the treatment of depression, where a combination of pharmacologic and psychological treatments are customized based on the severity of depression.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [114] source
- Interpretationcitation
A notable advance in the literature was the use of depression and/or anxiety screening and elevated symptom criteria for enrollment.
“A notable advance in the literature was the use of depression and/or anxiety screening and elevated symptom criteria for enrollment, an important element emphasized in the prior guideline.7”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] source
- Interpretationown data
An important methodologic advance was inclusion of process measures, that is, assessment during the course of treatment, seen in 17 RCTs, in addition to outcome measures.
“An important methodologic advance was inclusion of process measures, that is, assessment during the course of treatment, seen in 17 RCTs, in addition to outcome measures.”
Quote in the paperNot a substantial claim - Interpretationcitation
The pattern of response to educational interventions is broadly in line with that identified for depression in people without a chronic physical health problem.
“Although few recent trials investigate the effect of educational sessions, per se, to reduce depression and anxiety, the pattern of response to educational interventions is broadly in line with that identified for depression in people without a chronic physical health problem.[117][118][119]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [117][118][119]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation
Despite the limitations of the new evidence, responses are in accordance with previous research for treatment of anxiety in people with cancer.
“Despite the limitations of the new evidence, responses are in accordance with previous research for treatment of anxiety in people with cancer.[125][126][127][128][129]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [125][126][127][128][129]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
Depression treatment that was integrated with medical care, intensive, and systematically delivered by a well-trained and supervised team had large and sustained effects.
“It was shown that depression treatment that was integrated with medical care, intensive, and systematically delivered by a well-trained and supervised team had large and sustained effects.”
Quote in the paperSubstantial claim - Interpretationcitation
Evidence for pharmacotherapy is not compelling.
“The evidence is not compelling”
Quote in the paperSubstantial claim - Premisecitation
Meta-analyses show stronger posttreatment effects when coaching is used.
“contrasting with meta-analyses showing stronger posttreatment effects when coaching is used.132”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [132] source
- Interpretationnone given
Anxiety and depressive symptoms and disorders are not randomly distributed.
“Anxiety and depressive symptoms and disorders are not randomly distributed.”
Quote in the paperNot a substantial claim - Premisecitation
Disparities in survivors' mental health remain even when sociodemographic and psychosocial factors are considered.
“Disparities in survivors' mental health remain even when sociodemographic and psychosocial factors are considered.153,155”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [153] American Association for Cancer Research, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [155] source
- Premisecitation
Considerable progress toward the screening standard of care has been made, witnessed by the inclusion since 2015 of screening for distress as an accreditation criterion for cancer centers seeking Commission on Cancer certification.
“considerable progress toward this standard of care has been made, 136 as witnessed by the inclusion since 2015 of screening for distress as an accreditation criterion for cancer centers seeking Commission on Cancer certification.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [136] source
- Premisecitation
GAD is commonly comorbid with other disorders, primarily mood disorders or other anxiety disorders.
“it is commonly comorbid with others, primarily mood disorders or other anxiety disorders”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] source
- Premisecitation
A meta-analysis by Manea et al supports the .8 cutoff score for the PHQ-9.
“A meta-analysis by Manea et al also supports the .8 cutoff score.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Manea et al
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
GAD is the most prevalent of all anxiety disorders.
“it is the most prevalent of all anxiety disorders”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] source
- Premisecitation
GAD worry or fear may be disproportionate to actual cancer-related risk.
“Whereas cancer worries may be common for many, GAD worry or fear may be disproportionate to actual cancer-related risk”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] source
- May combine two claims. 75
- Classified as probably not a substantial claim. 59
May combine two claims.
InterpretationcitationSome studies with null effects were of lower methodological quality and/or potentially hampered by using an enhanced TAU control rather than a TAU control.
“Some studies with null effects were of lower methodological quality 103,105 and/or potentially hampered by using an enhanced TAU control rather than a TAU control.69,98”
Quote in the paperSubstantial claim2 of 4 sources checked- cites [103] source
The Results (Primary Outcome Analysis; page unavailable) report no difference between arms on the aggregated outcome, supporting the reference to a null effect. But Methods (Procedure; page unavailable) describes the control as receiving delayed INSPIRE access after the six-month assessment, not as an enhanced treatment-as-usual control; the paper does not suggest that such a control hampered the results. The lower-methodological-quality clause is attached to different citations. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [105] source
- cites [69] source
- cites [98] source
The citation to this trial is attached to the claim that a null effect may have been hampered by an enhanced TAU control. The Method (p. 1) and Discussion (p. 5) describe the comparison as CBT plus TAU versus TAU alone. The Limitations (p. 7) acknowledge that TAU could not be standardised, but say very few control participants reported any psychological intervention and none reported CBT; the paper does not describe an enhanced TAU control. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationThe López-López analyses document robust positive effects for both CBT and internet-delivered CBT, in studies using face-to-face, hybrid, or multimedia formats, in contrast to increased levels of depression found in waitlist control participants.
“Moreover, the L ópez-L ópez 54 analyses document robust positive effects for both CBT and internet-delivered CBT, in studies using face-to-face, hybrid, or multimedia formats, in contrast to increased levels of depression found in waitlist control participants.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [54] source
Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationDepressive symptoms are elevated for those with advanced disease stage and/or significant symptom burden.
“Depressive symptoms are elevated for those with advanced disease stage and/or significant symptom burden.14,15”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [14] source
The Results (page unavailable) associate stage IV disease with greater functional limitation due to emotional distress, and the Introduction (page unavailable) reports an association between cancer-related pain and emotional distress. The paper does not establish that depressive symptoms themselves are elevated with advanced stage or significant symptom burden; emotional distress and its functional effects are not the same measure. (LLM, conf=0.83)
Experimental — accuracy not yet measured - cites [15] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationDepression and anxiety usually co-occur in patients with cancer, as in those without cancer.
“As is the case for those without cancer, depression and anxiety usually co-occur.30”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [30] source
The Discussion reports the prevalence of major depression in the cancer cohort and its association with survival, but does not report whether depression and anxiety co-occur. Searches for depression–anxiety co-occurrence and comorbid anxiety found no passage addressing that claim or the comparison with people without cancer. Page numbers were not available in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationIn studies not screening patients for enrollment, CBT plus BT (relaxation) and education plus self-care significantly improved depression.
“In studies not screening patients for enrollment, CBT plus BT (relaxation) 77,100 and education plus self-care 123 significantly improved depression.”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [77] source
The Discussion (Strengths and Limitations) says the trial had no minimum cancer-related distress requirement for enrollment. The Results (Psychological Adaptation Indicators) report significant reductions in depressive affect, but CBT and relaxation training were separate treatment groups, not a combined intervention. The education-plus-self-care claim carries a different citation and is not assessed here. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [100] source
The Study Conditions and Results > Intervention Effects sections report that CBT-based stress management with relaxation training produced significantly fewer depressive symptoms than the psychoeducational control at five years. The Participants and Procedures section lists present or past major depressive disorder among the exclusion criteria, so the study does not fully support describing enrollment as unscreened. The separately cited education-plus-self-care claim is not attributed to this paper. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [123] source
May combine two claims.
FindingcitationStudy participants included in the long-term follow-up were older and reported fewer depressive symptoms and greater well-being at the time of diagnosis than those who did not participate.
“Study participants included in the long-term follow-up were older and reported fewer depressive symptoms and greater well-being at the time of diagnosis than those who did not participate.101”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [101] source
May combine two claims.
FindingcitationA psychoeducational intervention for gynecologic surgery patients and BT provided via a mobile app for patients with metastatic disease had no effect compared with an attention control or mobile health education app control, respectively.
“A psychoeducational intervention for gynecologic surgery patients 73 and BT provided via a mobile app for patients with metastatic disease had no effect compared with an attention control or mobile health education app control, respectively.76”
Quote in the paperNot a substantial claim1 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationA self-report bias may have played a role in the measures collected.
“Moreover, a self-report bias may have played a role in the measures collected.101”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [101] source
May combine two claims.
PremisecitationMeta-analyses evaluating MBSR interventions during and after cancer treatment demonstrate statistically significant improvements in both depression and anxiety compared with usual care.
“Meta-analyses evaluating the impact of MBSR interventions during and after cancer treatment demonstrate statistically significant improvements in both depression and anxiety compared with usual care.56,62,64”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [56] source
The Results (Primary and Secondary Outcomes; page unavailable) report statistically significant short- and medium-term reductions in anxiety and depression for mindfulness-based interventions. The anxiety subgroup result is significant for MBSR, and trials included interventions during and after cancer treatment. But the depression result pools multiple intervention types, and the comparisons pool usual care with other controls; the paper does not establish that MBSR specifically improved both outcomes compared with usual care. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [62] source
- cites [64] source
May combine two claims.
InterpretationcitationAlthough evidence of long-term benefit has been reported, the generalizability of this finding is limited.
“Although evidence of longterm benefit has been reported, 101 the generalizability of this finding is limited.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [101] source
May combine two claims.
FindingcitationIn one trial of screened patients with mixed cancer types, no significant difference between CBT versus TAU was found; however, uptake of CBT was limited, reducing the likelihood of detecting a treatment effect.
“In one trial of screened patients with mixed cancer types, no significant difference between CBT versus TAU 98 was found; however, uptake of CBT was limited, reducing the likelihood of detecting a treatment effect.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [98] source
The Main outcome (p. 5) reports no benefit from CBT versus treatment as usual, and the Limitations (p. 7) report limited therapy uptake. But the paper says low uptake *may* have reduced the overall treatment effect; it does not establish that it reduced the likelihood of detecting one. Its per-session analysis also found that even 12 sessions would not have produced a clinically meaningful change. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationTrials of problem-solving therapies alone or behavior change programs did not show a statistically significant benefit for depression.
“Trials of problem-solving therapies alone, 103 or behavior change programs 72 did not show a statistically significant benefit for depression.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [103] source
The Results (Planned Secondary Analyses of Individual Outcomes; page not supplied) report no difference from controls in depressive-symptom improvement for either intervention arm. However, this trial tested an online program alone or combined with problem-solving treatment, not problem-solving therapy alone. The separately cited behavior-change-program claim is outside this source’s attribution. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [72] source
May combine two claims.
PremisecitationSince the 2014 guideline, screening is a care aim that has been disseminated, but the principle and procedures remain to be fully implemented.
“Since the 2014 guideline, screening is a care aim that has been disseminated, but the principle and procedures remain to be fully implemented.134,135”
Quote in the paperNot a substantial claim1 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationMany patients from socially or economically marginalized communities have limited access to medical care and may not receive guideline concordant care.
“it is important to note that many patients from socially or economically marginalized communities have limited access to medical care and may not receive guideline concordant care.146”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [146] source
The Background says income, education, ethnicity and payer status may affect access to health care, supporting the access portion of the claim in the context of breast cancer. The Discussion explicitly says adherence to National Comprehensive Cancer Network treatment guidelines was not studied, so the paper does not establish that marginalized patients may receive non-guideline-concordant care. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationKnown factors that increase the risk of suicide in patients with cancer include older age at diagnosis, lower level of education, nonpartnered relationship status, living in rural or sparsely populated areas, psychological comorbidity, hopelessness, advanced stages of cancer, and poor performance status.
“There are several known factors that increase the risk of suicide in patients with cancer, including older age at diagnosis, lower level of education, nonpartnered relationship status, living in rural or sparsely populated areas, psychological comorbidity, hopelessness, advanced stages of cancer, and poor performance status.143,144”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [143] source
The Suicide Risk Factors table (p. 639) lists older age at diagnosis, lower education, rural residence, non-marital status, psychological comorbidity, and advanced cancer. Its physical-risk-factor entry lists poor physical functioning, which is close to, but not explicitly termed, poor performance status. The copy mentions the Beck Hopelessness Scale as a depression-assessment tool, but does not identify hopelessness itself as a suicide risk factor. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [144] Potter AL, 2023, JAMA Oncol
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationCBT and BA effects for depression and anxiety are robust, generalizing across sex, age, disease site, time in the cancer trajectory, and patients from the United States, English-speaking countries, Europe, and Asia.
“The CBT and BA effects for depression and anxiety are robust, generalizing across sex, age, disease site, time in the cancer trajectory, and patients from the United States, Englishspeaking countries, Europe, and Asia, all consistent with large-scale population-based US tests.142”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [142] source
The Abstract (Materials and Methods and Results; page not provided) reports improved anxiety and depression symptoms in 6,738 U.S.-based adults receiving blended-care CBT, supporting the large-scale U.S. results cited in the final clause. But the Methods (Study Design; page not provided) describes a self-referring, employer-benefit cohort, not a population-based sample. The paper does not establish effects of behavioral activation or generalization across cancer sites, stages, or countries outside the United States. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
Findingown dataAccrual of study participants occurred during active oncologic treatment in 20% of all included studies and during the post-treatment phase in 41%.
“Accrual of study participants occurred during active oncologic treatment in 20% of all included studies and during the post-treatment phase in 41%.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe duration of the interventions in the nonpharmacologic studies ranged from a single session to 24 sessions spanning 12 months.
“The duration of the interventions in the nonpharmacologic studies ranged from a single session to 24 sessions spanning 12 months.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAll but four studies provided a statistical power calculation, and some trials were underpowered to detect change, a situation worsened without screening.
“All but four studies 67,69,78,102 provided a statistical power calculation and some trials were underpowered to detect change, a situation worsened without screening.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data73% of the RCTs did not originate from the United States, but internationally from Europe, Asia, Australia, and Canada.
“It is noted that a substantial proportion (73%) of the RCTs did not originate from the United States, but internationally: Europe (10 studies), Asia (16 studies), Australia (four studies), and Canada (two studies).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOf the 44 RCTs, screening criteria of some type were used in 15 studies (34%) and not used in 66% of trials.
“Of the 44 RCTs, screening criteria of some type were used in 15 studies or 34% (42% [eight of 19] of depression studies; 33% [one of three] of anxiety studies; and 27% [six of 22] of depression plus anxiety studies) and not used in 66% of trials.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFor US-based studies, participation of individuals other than European or American ranged from 1% to 73%, with 12 studies reporting less than 30% ethnic and/or racial minority participation.
“For the US-based studies, ethnic and/or racial reporting varied in specificity and numbers, and participation of individuals other than European or American ranged from 1% to 73%, with 12 studies reporting ,30% ethnic and/or racial minority participation.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFollow-up was less than 3 months in seven studies and extended to 3 months or more in 20 studies.
“Follow-up was ,3 months in seven studies and extended to 3 months or more in 20 studies.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenThe time elapsed since cancer diagnosis ranged from less than a month to 5 years.
“The time elapsed since cancer diagnosis ranged from less than a month to 5 years.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenFew trials explored the causes of missingness or contrasted patients with complete versus incomplete (missing) data.
“Unfortunately, few trials explored the causes of missingness or contrasted patients with complete versus incomplete (missing) data.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataDepression outcomes in RCTs were assessed in multiple ways, with self-reports predominant and some use of structured diagnostic interviews.
“Depression outcomes in RCTs were assessed in multiple ways, with self-reports (Beck Depression Inventory-Second Edition and Center for Epidemiologic Studies Depression Scale) predominant and some use of structured diagnostic interviews (Hamilton Depression Rating Scale [HAM-D] and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAnxiety and/or depression treatment outcomes were assessed only before and after treatment in 17 RCTs and before, after, and with follow-up in 27 trials.
“Anxiety and/or depression treatment outcomes were assessed only before and after treatment in 17 RCTs and before, after, and with follow-up in 27 trials.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataSample sizes ranged from 62 to 500 in the RCTs using screening and 74 to 2,140 in RCTs with unscreened participants.
“Sample sizes ranged from 62 to 500 in the RCTs using screening and 74 to 2,140 in RCTs with unscreened participants.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
FindingcitationThe mean age of study participants ranged from 47.5 to 64 years, and the proportion of female participants varied from 11% to 100%, except one trial exclusively in men with prostate cancer.
“The mean age of study participants ranged from 47.5 to 64 years, and the proportion of female participants varied from 11% to 100%, with the exception of one trial exclusively in men with prostate cancer.97”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataApproximately one third of studies included two or more active treatment arms, either with an additional control arm (seven studies) or without (12 studies).
“However, approximately one third of studies included two or more active treatment arms, either with an additional control arm (seven studies) or without (12 studies).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataThe majority of the interventions were delivered face-to-face, although 12 studies involved remote options including telephone or virtual sessions.
“The majority of the interventions were delivered face-to-face, although 12 studies involved remote options including telephone or virtual sessions.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data36% of RCTs included patients with various cancer types and stages, and close to a third of studies were exclusively in patients with breast cancer.
“Many of the RCTs (36%) included patients with various cancer types and stages, although close to a third of studies were exclusively in patients with breast cancer.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationTwelve studies of psychological or social therapies with or without educational components were identified, with half screening patients for enrollment.
“Twelve studies of psychological or social therapies with or without educational components were identified, with half screening patients for enrollment.68,69,74,98,105,106”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Findingnone givenInterventions for managing both depression and anxiety were evaluated in 12 meta-analyses and one systematic review.
“Interventions for managing both depression and anxiety were evaluated in 12 meta-analyses and one systematic review.”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenMeta-analyses in patients with cancer report that exercise both during and after cancer treatment provides a moderate to large reduction in depression and may offer a reduction in anxiety.
“Meta-analyses in patients with cancer report that exercise both during and after cancer treatment provides a moderate to large reduction in depression and may offer a reduction in anxiety.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationIn terminally ill patients with cancer, methylphenidate as add-on therapy to mirtazapine improved antidepressant response from the third day of treatment onward, and resulted in clinically significant improved response rate from the second week onward.
“In terminally ill patients with cancer, methylphenidate as add-on therapy to mirtazapine improved antidepressant response from the third day of treatment onward, and resulted in clinically significant improved response rate, as measured by the Montgomery-Åsberg Depression Rating Scale, from the second week onward.89”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [89] source
May combine two claims.
Findingnone givenIn 11 of the meta-analyses, CBT was evaluated and all found CBT to result in significant reductions in depressive and anxiety symptoms.
“In 11 of the meta-analyses, CBT was evaluated and all found CBT to result in significant reductions in depressive and anxiety symptoms.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationThe RCT by Alamdarsaravi found significantly decreased HAM-D scores at 4 and 6 weeks compared with placebo, and significantly more responders at 6 weeks.
“The RCT by Alamdarsaravi found significantly decreased HAM-D scores at 4 and 6 weeks compared with placebo, and significantly more responders at 6 weeks.66”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [66] source
May combine two claims.
FindingcitationA published meta-analysis confirmed that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49; P = .003), and depression reduction was maintained at 12 months.
“A published meta-analysis, 115 which included these two studies along with five other RCTs, confirmed that collaborative care interventions were significantly more effective than usual care (standardized mean difference 5 20.49; P 5 .003),and depression reduction was maintained at 12 months.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [115] source
May combine two claims.
FindingcitationDepression care consisting of individually delivered multicomponent behavioral therapy, including BA and problem-solving, significantly reduced depressive symptoms compared with treatment as usual in patients with nonadvanced cancer, as well as in lung cancer patients with advanced disease.
“Depression care consisting of individually delivered multicomponent behavioral therapy, including BA and problem-solving, significantly reduced depressive symptoms compared with treatment as usual in patients with nonadvanced cancer, 99 as well as in lung cancer patients with advanced disease.107”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
FindingcitationHo reported null effects for both supportive expressive therapy and a mind-body-spirit intervention compared with an unstructured peer support group.
“Finally, Ho 79 reported null effects for both supportive expressive therapy and a mind-body-spirit intervention compared with an unstructured peer support group.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationTwo studies reported positive effects at day 3, a finding of unknown consequence.
“The Data Supplement outlines two studies 89,108 reporting positive effects at day 3, a finding of unknown consequence”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenMany of the interventions reviewed were delivered after primary oncologic treatments were completed.
“many of the interventions reviewed were delivered after primary oncologic treatments were completed.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).
Findingnone givenAll treatments in the palliative care RCTs were successful in significantly reducing anxiety and depressive symptoms.
“All treatments were successful in significantly reducing anxiety and depressive symptoms, with the exception of the Hoek trial, 80 which found null effects on depressive symptoms.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenSome components of the tested treatments may have empirical support (e.g., problem solving), whereas other components do not (e.g., diary keeping).
“Some components of the tested treatments may have empirical support (eg, problem solving), whereas other components do not (eg, diary keeping).”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationThe noninferiority trial comparing internet-delivered CBT without coaching versus with coaching showed no significant differences, and improvements occurred for both groups.
“The one noninferiority trial comparing internet-delivered CBT without coaching versus with coaching 75 showed no significant differences and improvements occurred for both groups”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOur systematic review shows CBT and BA achieve robust effects on symptom reduction.
“As for management, our systematic review shows CBT and BA achieve robust effects on symptom reduction.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationSeveral studies included assessments during the course of treatment.
“First, several studies included assessments during the course of treatment (eg, Zhao 111 )”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationTwo rigorous UK studies described a 10-session multicomponent BT treatment for MDD, which achieved depression remission and other gains with medication management.
“two rigorous studies from the United Kingdom 99,107 both described a 10-session multicomponent BT treatment for MDD, which achieved depression remission and other gains in which medication management was also provided.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThis review shows CBT and BA continue to be first-line treatments of choice, with added support for components used alone or in combination.
“This review shows these treatments continue to be first-line treatments of choice, with added support for components (eg, problem solving) used alone or in combination.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenOther studies had sample sizes just within the cutoff for systematic review inclusion (N=40).
“with other studies having sample sizes just within the cutoff for systematic review inclusion (N 5 40).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationAnxiety, of which generalized anxiety disorder is the most prevalent in this population, is common and continues to be an underaddressed condition.
“Along with depression, anxiety, of which generalized anxiety disorder is the most prevalent in this population, 19 is common and continues to be an underaddressed condition.[20][21][22]”
Quote in the paperNot a substantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn studies using diagnostic interviews, the prevalence of anxiety is approximately 10%.
“In studies using diagnostic interviews, the prevalence is approximately 10%.37”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] source
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningA conservative estimate of the number of patients with newly diagnosed cancer in 2023 with comorbid MDD is approximately 286,000 adults.
“Taken together, a conservative estimate (14.3%) of the number of patients with newly diagnosed cancer in 2023 with comorbid MDD will be approximately 286,000 adults.”
Quote in the paperNot a substantial claim- Rests on an assumption: When diagnostic criteria for MDD are used, the prevalence is 14.3%.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationArch et al found that 31% of patients with cancer with an anxiety disorder also had major depressive disorder (MDD).
“Notably, Arch et al 19 found that 31% of patients with cancer with an anxiety disorder also had major depressive disorder (MDD).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] source
May combine two claims.
PremisecitationStress, depression, and anxiety are prevalent and occur throughout the survivorship trajectory.
“stress, depression, and anxiety are prevalent and occur throughout the survivorship trajectory.8,9”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningA conservative estimate of the number of new cases having a comorbid anxiety disorder is 200,000 individuals.
“Again, a conservative estimate (10%) of the number of new cases having a comorbid anxiety disorder would be 200,000 individuals.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFor anxiety, studies using self-report instruments with specified cutoff points find prevalence estimates between 4% and 48%.
“For anxiety, studies using self-report instruments with specified cutoff points (eg, Hospital Anxiety and Depression Scale $ 8) find prevalence estimates between 4% and 48%.36”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [36] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenSystematic reviews and meta-analyses were evaluated using the assessment of multiple systematic reviews rating.
“Systematic reviews and metaanalyses were evaluated using the assessment of multiple systematic reviews rating”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe Expert Panel was assembled in accordance with ASCO's Conflict of Interest Policy Implementation for Clinical Practice Guidelines.
“The Expert Panel was assembled in accordance with ASCO's Conflict of Interest Policy Implementation for Clinical Practice Guidelines (”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenMembers of the Expert Panel reviewed and approved the penultimate version, which was circulated for external review and submitted to the Journal of Clinical Oncology for editorial review.
“Members of the Expert Panel were responsible for reviewing and approving the penultimate version of the guideline, which was then circulated for external review, and submitted to the Journal of Clinical Oncology for editorial review and consideration for publication.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenStudy quality was formally assessed for all 61 studies identified.
“Study quality was formally assessed for all 61 studies identified.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAll ASCO guidelines are ultimately reviewed and approved by the Expert Panel and the ASCO Evidence Based Medicine Committee before publication.
“All ASCO guidelines are ultimately reviewed and approved by the Expert Panel and the ASCO Evidence Based Medicine Committee before publication.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenAs is common in psychosocial intervention trials, having truly blind assessors is difficult to achieve, making use of standardized measures and evaluation of rater reliability critical design choices.
“As is common in psychosocial intervention trials, having truly blind assessors is difficult to achieve, making use of standardized measures and evaluation of rater reliability critical design choices.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataRCTs were evaluated for random assignment, allocation concealment, blinding of outcome assessment, baseline equivalence, loss to follow-up/missing data, and intent-to-treat analyses.
“To evaluate RCTs, research design characteristics including random assignment, allocation concealment, blinding of outcome assessment(s), baseline equivalence between groups, extent of loss to follow-up and/or missing data, and the use of intent-totreat analyses were evaluated”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy.
“In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenPubMed was searched from January 2013 through May 2021, restricted to meta-analyses, systematic reviews, and randomized controlled trials published in English.
“PubMed was searched from January 2013 through May 2021.The search was restricted to meta-analyses, systematic reviews, and randomized controlled trials (RCTs) published in English.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationCollaborative care is found to be superior to usual care and is more cost-effective than face-to-face and pharmacologic treatment for depression.
“This type of collaborative care is found to be superior to usual care 115 and is more cost-effective than face-to-face and pharmacologic treatment for depression.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [115] source
May combine two claims.
InterpretationreasoningThe diversity in the included studies precluded a quantitative analysis, so a qualitative review was performed.
“Overall, the diversity in the included studies precluded a quantitative analysis and, as such, a qualitative review was performed.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductcitationThe quality of the evidence for each outcome was assessed based on elements of the Cochrane Risk of Bias tool and the GRADE quality assessment and recommendations development process.
“The quality of the evidence for each outcome was assessed based on elements of the Cochrane Risk of Bias tool and the GRADE quality assessment and recommendations development process.45,46”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
InterpretationreasoningSmall sample sizes substantially increase the likelihood of baseline differences, but for some studies the sample sizes were more than adequate and yet statistically significant baseline differences were found.
“While small sample sizes substantially increase the likelihood of baseline differences, for some studies, the sample sizes were more than adequate (eg, N .145) and yet statistically significant baseline differences were found.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAll funding for the administration of the project was provided by ASCO.
“All funding for the administration of the project was provided by ASCO.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenArticles excluded were meeting abstracts not subsequently published, editorials, commentaries, letters, news articles, case reports, narrative reviews, and non-English publications.
“Articles excluded were the following: • Meeting abstracts not subsequently published in peerreviewed journals • Editorials, commentaries, letters, news articles, case reports, and narrative reviews • Publication in a non-English language.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAll members of the Expert Panel completed ASCO's disclosure form, which requires disclosure of financial and other interests.
“All members of the Expert Panel completed ASCO's disclosure form, which requires disclosure of financial and other interests, including relationships with commercial entities that are reasonably likely to experience direct regulatory or commercial impact as a result of promulgation of the guideline.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningMany trials had small sample sizes and/or high attrition rates impacting statistical power and lowering confidence in the findings.
“Many trials had small sample sizes and/or high attrition rates impacting statistical power and lowering confidence in the findings.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningData missingness elevates the risk of bias because the listed circumstances are nonrandom, and missingness is made worse by not determining its origins.
“Data missingness elevates the risk of bias as the listed circumstances are nonrandom, and missingness is made worse by not determining its origins.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationOther benefits of a stepped care model are opportunity for tailoring of patient care and optimized resource allocation.
“In addition to efficacy, other benefits of a stepped care model are opportunity for tailoring of patient care and optimized resource allocation.116”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [116] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn 2023, an estimated two million new cancer cases will be diagnosed in the United States.
“In 2023, an estimated two million new cancer cases will be diagnosed.31”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] American Cancer Society, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe guideline recommendations were posted for an open comment period of 2 weeks, allowing the public to review and comment.
“The guideline recommendations were posted for an open comment period of 2 weeks, allowing the public to review and comment on the recommendations after submitting a confidentiality agreement.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationreasoningThe detection of differences between active treatments demands large sample sizes, as the experimental question is degree of improvement, not improvement per se.
“Also, the detection of differences between active treatments demands large sample sizes, as the experimental question is degree of improvement, not improvement per se.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationreasoningEffective education in people with cancer and their families includes normalizing the experience, providing information about the nature and symptoms of depression and anxiety, and specifying the nature of symptom worsening that may warrant a call to the health care provider.
“Effective education in people with cancer and their families includes normalizing the experience, providing information about the nature and symptoms of depression and anxiety, and specifying the nature of symptom worsening that may warrant a call to the health care provider.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Interpretationnone givenHigh mortality can be expected in trials accruing patients with advanced disease and/or in the palliative care setting, but even death is a nonrandom event.
“High mortality can be expected in trials accruing patients with advanced disease and/or in the palliative care setting, but even death is a nonrandom event.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenEach included publication was assessed for methodological quality by one methodologist.
“Each included publication was assessed for methodological quality by one methodologist.”
Quote in the paperNot a substantial claim- Rests on an assumption: Assessment of methodological quality by a single methodologist is sufficient to determine study quality.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe 2014 ASCO guideline was an adaptation of a Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer.
“The 2014 guideline was an adaptation of a Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer, 44 which addressed the following three research questions:”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [44] Howell DKH, Esplen MJ, Hack T, et al: A Pan Canadian Practice Guideline: Screening, assessment and care of psychosocial distress, depression, and anxiety in adults with cancer, in Canadian Partnership Against Cancer and the Canadian Association of Psychosocial Oncology (ed). Toronto, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenThe historical weight of evidence for CBT and BA is most compelling.
“However, the historical weight of evidence for CBT and BA is most compelling.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationIn a meta-analysis of 14 studies with over 900 patients, exercise had a large effect compared with usual care for both depression and anxiety.
“In a meta-analysis of 14 studies with over 900 patients, Singh et al 59 reported a large effect in favor of exercise compared with usual care for both depression and anxiety.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Singh et al 59
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationreasoningIn particular, psychosocial interventions, stress reduction strategies, and a combination of CBT, hypnosis, and support are effective over standard care.
“In particular, psychosocial interventions, stress reduction strategies, and a combination of CBT, hypnosis, and support are effective over standard care.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataNone of the anxiety interventions could be characterized as testing empirically supported anxiety treatments but rather stress reduction strategies, with some addition of behavioral therapy strategies or education.
“None of the interventions could be characterized as testing empirically supported anxiety treatments (eg, BA, exposure) but rather stress reduction strategies (eg, relaxation, hypnosis), with some addition of behavioral therapy strategies (activity planning, problem solving), or education.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe McGettigan et al meta-analysis found no significant difference in depression nor anxiety with physical activity in the short term or medium term.
“The meta-analysis by McGettigan et al 55 found no significant difference in depression nor anxiety with PA in the short term or medium term.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites McGettigan et al 55
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationcitationBoth celecoxib trials were small, with 52 and 40 participants, respectively, and included samples in which a COX-2 inhibitor might have also contributed to improved physical symptoms.
“However, both trials were small, with 52 and 40 participants, respectively, and included samples in which a COX-2 inhibitor might have also contributed to improved physical symptoms.”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationCorrelates of elevated symptoms include current or prior psychiatric diagnosis, other chronic medical conditions, adverse social determinants of health, and poor functional status.
“Correlates of elevated symptoms include those with a current or prior psychiatric diagnosis, other chronic medical conditions, adverse social determinants of health, and poor functional status, among others (Table 3).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Table 3
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningScreening has the potential benefit of reducing sample size.
“In RCTs, screening of patients is essential (used in only one third of studies) and has the potential benefit of reducing sample size.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningData loss threatens the reliability and validity of findings.
“Data loss threatens the reliability and validity of findings.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningIn RCTs, screening of patients is essential.
“In RCTs, screening of patients is essential (used in only one third of studies) and has the potential benefit of reducing sample size.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Interpretationnone givenOther decisions can reduce statistical power, such as small sample sizes, sizes insufficient to detect effects between active treatments, or sample size reduced across time.
“Other decisions can reduce statistical power, such as small sample sizes in general, sizes insufficient to detect effects between active treatments, or when any sample size is reduced across time.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationFactors such as race and ethnicity, age, socioeconomic status, sexual orientation and gender identity, geographic location, and access to medical and mental health insurance are known to impact cancer care outcomes.
“Factors such as race and ethnicity, age, socioeconomic status, sexual orientation and gender identity, geographic location, and access to medical and mental health insurance are known to impact cancer care outcomes.148”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [148] source
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenHigh mortality may be anticipated in trials accruing patients with advanced disease and/or in the palliative care setting.
“As noted earlier, high mortality may be anticipated in trials accruing patients with advanced disease and/or in the palliative care setting.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationEarlier trials show negative effects for peer support conditions, countering assumptions of peer support being uniformly beneficial.
“These data align with earlier trials showing negative effects for peer support conditions, 133 countering assumptions of peer support being uniformly beneficial.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [133] source
May combine two claims.
Study design and conductown dataRisk of bias was low in one trial, with the others having high risk of bias in two or three key areas.
“Risk of bias was low in one trial, 104 with the others having high risk of bias in two 80 or three 81 key areas.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationPatients with cancer who are members of racial and/or ethnic minorities suffer disproportionately from comorbidities, experience more substantial obstacles to receiving care, are more likely to be uninsured, and are at greater risk of receiving fragmented care or poor-quality care than other Americans.
“Patients with cancer who are members of racial and/or ethnic minorities suffer disproportionately from comorbidities, experience more substantial obstacles to receiving care, are more likely to be uninsured, and are at greater risk of receiving fragmented care or poor-quality care than other Americans.[149][150][151][152]”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [149] US Cancer Statistics Working Group, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [150] Surveillance, Epidemiology, and End Results (SEER): Cancer Statistics Review, 1975-2017. Bethesda, MD, NIH publication, 1975-2017, 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [151] Mead H, 2008
- cites [152] American Cancer Society, 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningBaseline group differences are less likely when randomizing within strata, as variables potentially correlated with the outcome can reduce nuisance subject variance.
“a circumstance less likely when randomizing within strata, as variables potentially correlated with the outcome can reduce nuisance subject variance.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningSuch approaches limit the interpretation of the findings and hinder replication by other investigators and the accumulation of knowledge supporting one treatment over another.
“Such approaches limit the interpretation of the findings, and hinder replication by other investigators and the accumulation of knowledge supporting one treatment over another.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenFinding significant pre-treatment to post-treatment effects is necessary but often not sufficient to confirm treatment effectiveness with depressed or anxious patients.
“Finding significant pre-treatment to post-treatment effects is necessary but often not sufficient to confirm treatment effectiveness with depressed or anxious patients.”
Quote in the paperNot a substantial claim- Rests on an assumption: MDD is known not to improve or improve and then worsen.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe pathognomic GAD symptom, multiple excessive worries, may present as concerns or fears.
“The pathognomic GAD symptom, ie, multiple excessive worries, may present as concerns or fears.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] source
May combine two claims.
InterpretationreasoningOmitting the self-harm item from the PHQ-9 may artificially lower the score, with the risk of some patients appearing to have fewer symptoms than they actually do.
“It should be noted, however, that doing so may artificially lower the score, with the risk of some patients appearing to have fewer symptoms than they actually do.”
Quote in the paperSubstantial claim- Rests on an assumption: One of the remaining seven items of the PHQ-9 assesses thoughts of self-harm.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAn individual with GAD has worries about a range of other, noncancer topics and areas of his/her life.
“Importantly, an individual with GAD has worries about a range of other, noncancer topics and areas of his/her life.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] source
May combine two claims.
PremisecitationThis disparity widens in survivors who are also from a racial or ethnic minority, underscoring the influence of intersectionality in cancer health disparities.
“This disparity widens in survivors who are also from a racial or ethnic minority, underscoring the influence of intersectionality in cancer health disparities.153,158”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [153] American Association for Cancer Research, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [158] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTwo draft statements achieved 100% agreement, 10 achieved >90% agreement, and four achieved >85% agreement; none achieved <85% agreement.
“Two draft statements achieved 100% agreement, 10 achieved .90%agreement, and four draft statements received .85%agreement.None of the draft recommendations achieved ,85% agreement.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe CAPO and the Canadian Partnership Against Cancer guideline recommends screening for psychosocial health care needs at initial diagnosis, start of treatment, regular intervals during treatment, end of treatment, post-treatment or transition to survivorship, recurrence or progression, advanced disease, when dying, and during times of personal transition or reappraisal.
“The CAPO and the Canadian Partnership Against Cancer (the Partnership) guideline Assessment of Psychosocial Health Care Needs of the Adult Cancer Patient suggests screening at initial diagnosis, start of treatment, regular intervals during treatment, end of treatment, post-treatment or at transition to survivorship, at recurrence or progression, advanced disease, when dying,”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites CAPO and the Canadian Partnership Against Cancer guideline
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThe patient's endorsement of multiple symptoms defines the need for services for moderate/severe to severe symptomatology.
“Thus, it is the patient's endorsement of multiple symptoms that will define the need for services for moderate/ severe to severe symptomatology.”
Quote in the paperNot a substantial claim- Rests on an assumption: Individuals do not typically endorse a self-harm item exclusively or independent of other symptoms; rather, it occurs with several other symptom endorsements.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPatients with GAD do not necessarily present with symptoms of anxiety, per se.
“Patients with GAD do not necessarily present with symptoms of anxiety, per se.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe draft was submitted to two external reviewers with content expertise; it was rated as high quality and agreed it would be useful in practice.
“The draft was submitted to two external reviewers with content expertise.It was rated as high quality, and it was agreed it would be useful in practice.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe draft recommendations were released for public open comment from September 19 through October 3, 2022, with 126 written comments received from 28 respondents.
“The draft recommendations were released to the public for open comment from September 19 through October 3, 2022.Response categories of”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
InterpretationreasoningOmitting the self-harm item weakens the predictive validity of the score and the clarity of the cutoff scores.
“Such changes also weaken the predictive validity of the score and the clarity of the cutoff scores.”
Quote in the paperSubstantial claim- Rests on an assumption: One of the remaining seven items of the PHQ-9 assesses thoughts of self-harm.
The paper relies on this without support.
Adults diagnosed with cancer report higher levels of stress than healthy controls, with diagnosis and the start of treatment being the most stressful times.
“Adults diagnosed with cancer report higher levels of stress than healthy controls, with diagnosis and the start of treatment being the most stressful times.”
The paper relies on this without support.
The most common depressive disorders among patients with cancer are major depression and adjustment disorder, with data for other depressive disorders scarce.
“The most common depressive disorders among patients with cancer are major depression and adjustment disorder, with data for other depressive disorders scarce.”
The paper relies on this without support.
Depression is often accompanied by functional impairment, poorer physical health, substance use, and low quality of life, influenced by impaired relationships, reduced physical activity, and other factors.
“Depression is often accompanied by functional impairment, poorer physical health, substance use, and low quality of life, influenced in turn by impaired relationships, reduced physical activity (PA), and other factors.”
The paper relies on this without support.
Clinical depression does not remit, and patients remain at risk for self harm and/or suicide.
“Clinical depression does not remit, and patients remain at risk for self harm and/or suicide.”
The paper relies on this without support.
A possible danger exists for depressed patients who are not treated.
“In addition to the psychological, behavioral, and biologic disruption associated with depression and anxiety after cancer, a possible danger exists for depressed patients who are not treated.”
The paper relies on this without support.
When diagnostic criteria for MDD are used, the prevalence is 14.3%.
“When diagnostic criteria for MDD are used, the prevalence is 14.3%.”
The paper relies on this without support.
Assessment of methodological quality by a single methodologist is sufficient to determine study quality.
“Each included publication was assessed for methodological quality by one methodologist.”
The paper relies on this without support.
Problems with access to psychological care for cancer patients with depression and/or anxiety can be attributed to organizational and workforce obstacles, such as a shortage of mental health professionals, and limited referral networks for managing depression and anxiety.
“Problems with access to psychological care for cancer patients with depression and/or anxiety can be attributed to organizational and workforce obstacles, such as a shortage of mental health professionals, and limited referral networks for managing depression and anxiety.”
The paper relies on this without support.
MDD is known not to improve or improve and then worsen.
“particularly for disorders such as MDD known not to improve or improve and then worsen.”
The paper relies on this without support.
Social determinants of health such as race/ethnicity, gender identity, and socioeconomic status covary with adverse cancer and mental health outcomes.
“It is known that social determinants of health such as these covary with adverse cancer and mental health outcomes.”
The paper relies on this without support.
The mental health care crisis is a widespread issue that affects individuals with all types of medical conditions, including patients with cancer.
“The mental health care crisis is a widespread issue that affects individuals with all types of medical conditions, including patients with cancer.”
The paper relies on this without support.
It is estimated that 25%-30% of patients would need to complete the remaining items of the PHQ-9 after endorsing the first two items.
“It is estimated that 25%-30% of patients would need to complete the remaining items.”
The paper relies on this without support.
The traditional cutoff for the PHQ-9 is .10.
“The traditional cutoff for the PHQ-9 is .10.”
The paper relies on this without support.
One of the remaining seven items of the PHQ-9 assesses thoughts of self-harm.
“Of special note, one of remaining seven items of the PHQ-9 assesses thoughts of self-harm, ie, thoughts that you would be better off dead or hurting yourself in some way.”
The paper relies on this without support.
Among patients with moderate to severe or severe depression, thoughts of self-harm are not rare.
“Among patients with moderate to severe or severe depression, such thoughts are not rare.”
The paper relies on this without support.
Individuals do not typically endorse a self-harm item exclusively or independent of other symptoms; rather, it occurs with several other symptom endorsements.
“It is important to note that individuals do not typically endorse a self-harm item exclusively or independent of other symptom; rather, it occurs with several other symptom endorsements.”
The paper relies on this without support.
A range of problem checklists is available to guide the assessment of possible stressors.
“A range of problem checklists is available to guide the assessment of possible stressors.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
ACT as a therapeutic treatment modality for survivors has a growing evidence base, supporting survivors in cultivating present-moment awareness and disentangling from rigid thoughts about themselves and their cancer.
“ACT as a therapeutic treatment modality for survivors has a growing evidence base [37,57-59], supporting survivors in cultivating present-moment awareness and disentangling from rigid thoughts about themselves and their cancer [60].”
From Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach (2024) · cites this paper as [37]
The anxiety care map lists acceptance and commitment therapy as an intervention option for adults with cancer, supporting its use as a treatment modality. The passages found do not establish that its evidence base is growing. The description of present-moment awareness and disentangling from rigid thoughts is attached to a different citation [60], not this source. (LLM, conf=0.78)
Experimental — accuracy not yet measuredACT has shown effectiveness in improving health outcomes for breast cancer survivors and is a recommended evidence-based treatment for cancer survivors by the American Society of Clinical Oncology.
“We predetermined the use of ACT as the foundation for the design of the MOSAIC app because it has shown effectiveness in improving health outcomes for breast cancer survivors [33] and is a recommended evidence-based treatment for cancer survivors by the American Society of Clinical Oncology [37].”
From Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach (2024) · cites this paper as [37]
The guideline’s generalized-anxiety care map (page unavailable) lists acceptance and commitment therapy as a low-intensity intervention option for adults with cancer. This supports the ASCO-recommendation portion attributed to [37], but the citing sentence omits that the recommendation is for managing anxiety; it does not establish ACT as a treatment for cancer survivors generally. The breast-cancer effectiveness claim is attached to a different citation. (LLM, conf=0.84)
Experimental — accuracy not yet measuredACT is listed as one of several evidence-based treatments for adult cancer survivors with moderate symptoms of anxiety in the American Society of Clinical Oncology clinical practice guidelines for depression and anxiety.
“Furthermore, ACT is listed as 1 of several evidence-based treatments for adult cancer survivors with moderate symptoms of anxiety in the American Society of Clinical Oncology clinical practice guidelines for depression and anxiety [37].”
From Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach (2024) · cites this paper as [37]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Moderate-anxiety recommendation omits a treatment endorsed in the abstract
MajorThe abstract says clinicians should offer acceptance and commitment therapy for moderate anxiety, but the corresponding numbered recommendation does not include it among the options clinicians should offer.
“For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions.”
“Recommendation 3.2.For a patient with moderate symptoms of anxiety, clinicians should offer individual or group therapy with any one of the following treatment options: • CBT • BA • Structured PA and exercise • Psychosocial interventions with empirically supported components (eg, relaxation, problem solving)”
Depression care map excludes stated exceptions for starting medication
MajorThe care map says medication is considered only after previous therapies fail to produce remission. Recommendation 2.4 also permits it when first-line treatment is inaccessible or the patient prefers medication, without requiring a prior treatment attempt.
“Pharmacologic (only considered following previous therapies if remission has not occurred)”
“Recommendation 2.4.Treating clinicians may offer a pharmacologic regimen for depression in patients without access to firstline treatment, those expressing a preference for pharmacotherapy, or those who do not improve following first-line psychological or behavioral management.”
The same study is assigned two different interventions
MinorTable 2 identifies Wang 2020, reference 108, as an internet-delivered psychoeducation study in its review section and as a ketamine trial in its pharmacologic section.
“| Wang 2020 108 | Psychoeducation (internet-delivered) | √ | |”
“| Wang 2020 108 | Ketamine | √ | |”
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BackgroundMajor Depression and Survival in People With Cancer
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“02).(4) Using self-report instruments with specified cutoff points (eg, Patient Health Questionnaire-9 $ 10), moderate to severe depressive symptom rates between 13% and 27% have been reported.”
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Carlson, L. E., Ismaila, N., Addington, E. L., Asher, G. N., Atreya, C. E., Balneaves, L. G., Bradt, J., Fuller-Shavel, N., Goodman, J., Hoffman, C. J., et al. (2023) · Journal of Clinical Oncology · doi:10.1200/jco.23.00857 · Cited by 331 · see citing works
“This finding is synergistic with the updated ASCO guideline review of the psychosocial, behavioral, and pharmacologic management of anxiety and depression in adult cancer survivors in which MBSR interventions, among other cognitive-behavioral and individual psychologic therapies, were strongly recommended by the revie…”
ResultSelf-citationBower, J. E., Lacchetti, C., Alici, Y., Barton, D. L., Bruner, D. W., Canin, B. E., Escalante, C. P., Ganz, P. A., Garland, S. N., Gupta, S., et al. (2024) · Journal of Clinical Oncology · doi:10.1200/jco.24.00541 · Cited by 314 · see citing works
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BackgroundSelf-citationFertility Preservation in People With Cancer: ASCO Guideline Update
Su, H.-C. I., Lacchetti, C., Letourneau, J. M., Partridge, A. H., Qamar, R., Quinn, G. P., Reinecke, J. D., Smith, J. F., Tesch, M. E., Wallace, W. H., et al. (2025) · Journal of Clinical Oncology · doi:10.1200/jco-24-02782 · Cited by 311 · see citing works
Self-citationCannabis and Cannabinoids in Adults With Cancer: ASCO Guideline
Braun, I. M., Bohlke, K., Abrams, D. I., Anderson, H., Balneaves, L. G., Bar-Sela, G., Bowles, D. W., Chai, P. R., Damani, A., Gupta, A., et al. (2024) · Journal of Clinical Oncology · doi:10.1200/jco.23.02596 · Cited by 115 · see citing works
Hurt, R. T., Stephenson, C. R., Gilman, E. A., Aakre, C. A., Croghan, I. T., Mundi, M. S., Ghosh, K., & Edakkanambeth Varayil, J. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251332215 · Cited by 78 · see citing works
Hart, N. H., Nekhlyudov, L., Smith, T. J., Yee, J., Fitch, M. I., Crawford, G. B., Koczwara, B., Ashbury, F. D., Lustberg, M. B., Mollica, M. A., et al. (2024) · JCO Oncology Practice · doi:10.1200/op.23.00716 · Cited by 59 · see citing works
Self-citationThe human crisis in cancer: a Lancet Oncology Commission
Rodin, G., Feldman, A., Trapani, D., Skelton, M., Unger‐Saldaña, K., Essue, B. M., Pihlak, R., Walshe, C., Rosa, W. E., Banegas, M. P., et al. (2025) · The Lancet Oncology · doi:10.1016/s1470-2045(25)00530-3 · Cited by 67 · see citing works
Duan, L., Zhang, S., Yan, Q., & Hu, X. (2025) · Psycho-Oncology · doi:10.1002/pon.70078 · Cited by 47 · see citing works
“Cognitive behavior therapy (CBT) is one of the most promising nonpharmacological treatments and is endorsed by the American Society of Clinical Oncology (ASCO) [21].”
Li, J., He, H. G., Guan, C., Ding, Y., & Hu, X. (2025) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2025.110993 · Cited by 44 · see citing works
Bergerot, C. D., Bergerot, P. G., Philip, E. J., Ferrari, R., Peixoto, R. M., Crane, T. E., Schmitz, K. H., & Soto‐Pérez‐de‐Celis, E. (2024) · JCO Global Oncology · doi:10.1200/go-24-00333 · Cited by 44 · see citing works
Hart, N. H., Nekhlyudov, L., Smith, T. J., Yee, J., Fitch, M. I., Crawford, G. B., Koczwara, B., Ashbury, F. D., Lustberg, M. B., Mollica, M. A., et al. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08465-8 · Cited by 43 · see citing works
Self-citationHall, D. L., Wagner, L. I., Lebel, S., Smith, A. B., Bergerot, C., & Park, E. R. (2024) · Cancer · doi:10.1002/cncr.35326 · Cited by 31 · see citing works
“4 However, FCR management was not discussed in the 2023 ASCO update 1 and remains unaddressed in US guidelines.”
Aerobic Physical Activity and Depression Among Patients With Cancer
Kulchycki, M., Halder, H., Askin, N., Rabbani, R., Schulte, F., Jeyaraman, M., Sung, L., Louis, D., Lix, L., Garland, A., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.37964 · Cited by 21 · see citing works
Tang, M., Su, Z., He, Y., Pang, Y. K., Zhou, Y., Wang, Y., Lu, Y., Jiang, Y., Han, X., Song, L., et al. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-04788-7 · Cited by 25 · see citing works
“These findings also confirm previous findings [24, 25] that anxiety and depression have a high level of coexistence.”
ResultCarlson, L. E., Ismaila, N., Addington, E. L., Asher, G. N., Bradt, J., Mehta, A., & Rowland, J. H. (2023) · JCO Oncology Practice · doi:10.1200/op.23.00358 · Cited by 23 · see citing works
Self-citationPark, Y.-E., Tak, Y. W., Kim, I., Lee, H. J., Lee, J. B., Lee, J. W., & Lee, Y. (2024) · Journal of Medical Internet Research · doi:10.2196/55176 · Cited by 23 · see citing works
“Physical activity is encouraged to cope with anxiety and depression in patients with cancer, and outdoor physical activity in patients with cancer can be promoted by organized activities [65,66].”
Steel, J. L., George, C. J., Terhorst, L. A., Yabes, J. G., Reyes, V. E., Zandberg, D. P., Nilsen, M. L., Kiefer, G. J., Johnson, J. T., Marsh, C., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00015-1 · Cited by 21 · see citing works
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis: One Decade Later
Nekhlyudov, L., Levit, L. A., & Ganz, P. A. (2024) · Journal of Clinical Oncology · doi:10.1200/jco-24-01243 · Cited by 21 · see citing works
Self-citationManagement of Cancer During Pregnancy: ASCO Guideline
Loren, A. W., Lacchetti, C., Amant, F. C., Cardonick, E. H., Carey, L., Christian, N., Clark, C. C., Dizon, D. S., Henry, M., Hudson, M. M., et al. (2025) · Journal of Clinical Oncology · doi:10.1200/jco-25-02115 · Cited by 24 · see citing works
Self-citationWang, Y., Zhang, X., Wang, X., Zhang, Y., Jin, Y., & Li, W. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3023 · Cited by 18 · see citing works
Review of the Use of Medicinal Cannabis Products in Palliative Care
Troyer, J., & Tanco, K. C. (2024) · Cancers · doi:10.3390/cancers16071412 · Cited by 17 · see citing works
“Cancer patients, including those receiving cancer therapy, can experience impaired sleep and mood-related disorders [60–62].”
BackgroundOmari, M., Amaadour, L., Asri, A. E., Benbrahim, Z., Mellas, N., Rhazi, K. E., Ragala, M. E. A., Hilaly, J. E., Halim, K., & Zarrouq, B. (2024) · Women s Health · doi:10.1177/17455057241276232 · Cited by 16 · see citing works
“38 By referring to recent guidelines on the management of distress, depression, and anxiety, 17,98,99 we identified other interventions for patients with BC.”
BackgroundMeoded, M. D., Tănase, M., Mehedințu, C., & Cirimbei, C. (2025) · Medicina · doi:10.3390/medicina61061008 · Cited by 15 · see citing works
Graboyes, E. M., Kistner‐Griffin, E., Hill, E. G., Maurer, S. N., Balliet, W. E., Williams, A. M., Padgett, L. S., Yan, F., Rush, A., Johnson, B., et al. (2023) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01454-6 · Cited by 17 · see citing works
“CBT is an effective treatment for depression among cancer survivors and one of the recommended 1 st line therapies for cancer survivors with moderate depression [41, 42].”
Mental health and care utilization in survivors of adolescent and young adult cancer
Baclig, N. V., Comulada, W. S., & Ganz, P. A. (2023) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkad098 · Cited by 14 · see citing works
“Follow-up care should include regular symptom screening with validated tools such as the PHQ-8 and GAD-7, as recommended by the recent update on management of anxiety and depression in adult cancer survivors (37).”
Oberoi, S., Garland, A., Yan, A. P., Lambert, P. J., Xue, L., Decker, K., Israels, S. J., Banerji, S. O., Bolton, J. M., Deleemans, J. M., et al. (2024) · Journal of Clinical Oncology · doi:10.1200/jco.23.01615 · Cited by 14 · see citing works
“39-42 Our observation of a higher incidence of mood and anxiety disorders immediately postdiagnosis concurs with a report by Lu et al. 43 However, this study did not consider death as a competing risk, focused on adults of all ages, and no adjustments were made for morbidities and socioeconomic…”
ResultCrichton, M., Dissanayaka, T. D., Marx, W., Gamage, E., Travica, N., Bowers, A. P., Isenring, E. A., Yates, P. M., & Marshall, S. (2024) · Maturitas · doi:10.1016/j.maturitas.2024.107941 · Cited by 14 · see citing works
From Biomarkers to Behavior: Mapping the Neuroimmune Web of Pain, Mood, and Memory
Tanaka, M., & Battaglia, S. (2025) · Biomedicines · doi:10.3390/biomedicines13092226 · Cited by 13 · see citing works
“Evidence thus advocates early, personalized activity prescriptions to blunt cascading affective and nociceptive burdens and to integrate mental-health prevention into routine oncology pain care [75,77,78,80].”
Jiménez-Labaig, P., Aymerich, C., Rullan, A., Cacicedo, J., Braña, I., Nutting, C. M., Newbold, K. L., Harrington, K. J., & Catalán, A. (2024) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2024.110649 · Cited by 15 · see citing works
Saracino, R. M., Kehoe, L., Sohn, M. B., Wang, L., Mohile, S. G., Wells, M., Mustian, K. M., Morrow, G. R., Bradley, T. P., Onitilo, A. A., et al. (2024) · Psycho-Oncology · doi:10.1002/pon.70012 · Cited by 13 · see citing works
“As such, ASCO guidelines were recently updated to recommend the utilization of a stepped‐care model in which the most effective and least resource‐intensive intervention is offered to a patient based on symptom severity [12].”
Cancer and Stress: Understanding the Connections and Interventions
D’Andre, S. D., Ellsworth, L. L., Kirsch, J. L., Montane, H. N., Kruger, M. B., Donovan, K. A., Bronars, C. A., Markovic, S. N., & Ehlers, S. L. (2024) · American Journal of Lifestyle Medicine · doi:10.1177/15598276241304373 · Cited by 13 · see citing works
Schuman, H. D. M., Savard, C., Mina, R., Barkova, S., Conradi, H. S. W., Deleemans, J. M., & Carlson, L. E. (2025) · Current Oncology · doi:10.3390/curroncol32070380 · Cited by 13 · see citing works
Nardin, S., Ruffilli, B., Landolfo, T. L., Isingrini, G., Taglialatela, I., Delbarba, A., D’Avanzo, F., Rossi, V., Celentano, E., Conte, B., et al. (2025) · Cancers · doi:10.3390/cancers17172726 · Cited by 14 · see citing works
“As outlined in the recent ASCO guidelines, the decision to initiate pharmacological treatment must be individualized, considering symptom burden, patient preference, and overall risk–benefit profile [147].”
Faro, J. M., Dressler, E. V. M., Kittel, C., Beeler, D., Bluethmann, S. M., Sohl, S. J., McDonald, A. M., Weaver, K. E., Nightingale, C. L., Neuman, H. B., et al. (2024) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkae005 · Cited by 13 · see citing works
“These guidelines recommend using a stepped-care model to provide the most effective and least resource-intensive intervention based on symptom severity (34).”
Core‐curriculum in psycho‐oncology: Towards the certification of the psycho‐oncologist profession
Grassi, L., & Watson, M. (2024) · Psycho-Oncology · doi:10.1002/pon.6285 · Cited by 13 · see citing works
Tian, S., Liang, Z., Tian, M., Qiu, F., Yu, Y., Mou, H., & Gao, Y. (2024) · Age and Ageing · doi:10.1093/ageing/afae211 · Cited by 12 · see citing works
Gascon, B., Elman, J., Macedo, A., Leung, Y. W., Rodin, G., & Li, M. (2024) · Current Oncology · doi:10.3390/curroncol31110481 · Cited by 12 · see citing works
Anxiety and depression among patients newly diagnosed with lymphoma and myeloma
Odejide, O. O., Cronin, A. M., Gray, T. F., et al. (2025) · Blood Advances · doi:10.1182/bloodadvances.2024014821 · Cited by 12 · see citing works
“34 The fact that lower social support conferred almost 3-times higher odds of experiencing depressive symptoms than those with perceived higher social support suggests that social support has a crucial role in buffering mental well-being.”
Reduced Mortality With Treatment of Anxiety and Depression Among Head and Neck Cancer Survivors
Gallagher, T. J., Lin, M. E., Kim, I., Kwon, D. I., & Kokot, N. (2025) · The Laryngoscope · doi:10.1002/lary.32340 · Cited by 12 · see citing works
“Currently, while studies have shown an association between the treatment of anxiety and depression and reduced mortality among other cancer survivors, there is no consensus regarding the relative advantage of one modality compared to the other [46, 47].”
Patient-Clinician Communication: ASCO Guideline Update
Gilligan, T. D., Bohlke, K., Alpert, A. B., Coyle, N., Harichand-Herdt, S., Lathan, C. S., Razis, E., Rivera, K., Sanft, T. B., Seigel, C., et al. (2026) · Journal of Clinical Oncology · doi:10.1200/jco-26-00118 · Cited by 20 · see citing works
Depression in patients with hematologic malignancies: The current landscape and future directions.
Kuczmarski, T., Roemer, L., & Odejide, O. (2024) · Blood reviews · doi:10.1016/j.blre.2024.101182 · Cited by 11 · see citing works
Smith, A. B., Girgis, A., Taylor, N. J., Pearce, A. M., Liu, J., Shepherd, H. L., Wu, V. S., Garvey, G., Kirsten, L. T., Zakhary, I., et al. (2024) · Journal of Cancer Survivorship · doi:10.1007/s11764-024-01685-1 · Cited by 17 · see citing works
Long-Term Follow-Up Care After Treatment for Primary Breast Cancer: Strategies and Considerations
Franzoi, M. A., Janni, W. J., Erdmann-Sager, J., Kline‐Quiroz, C. M., Schäffler, H., Pfister, K., Fazzalari, A., & Vaz-Luís, I. (2025) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk-25-473472 · Cited by 10 · see citing works
Wang, H., Wang, M., Wang, X., Feng, T., Liu, X., & Xiao, W. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1502252 · Cited by 11 · see citing works
“Studies indicate that individuals diagnosed with anxiety often exhibit depressive symptoms, and vice versa, with comorbidity rates ranging from 40% to 60% in various populations (1 – 3).”
Patient Attitudes Toward Artificial Intelligence in Cancer Care: Scoping Review
Hilbers, D., Nekain, N., Bates, A. T., & Nuñez, J.-J. (2025) · JMIR Cancer · doi:10.2196/74010 · Cited by 13 · see citing works
“Patients with metastatic disease may have distinct concerns regarding AI, including fears that AI-driven prognostic models could recommend less aggressive treatment options if the predicted prognosis is poor, rather than prioritizing patient preferences [15,16,31,46].”
Review of Psilocybin Use for Depression among Cancer Patients after Approval in Oregon
Bellman, V. (2024) · Cancers · doi:10.3390/cancers16091702 · Cited by 8 · see citing works
“Additionally, addressing depression can significantly improve cancer patients’ overall quality of life by reducing their physical and emotional distress and improving their ability to cope with the challenges of treat-ment [26,27].”
BackgroundPetridis, P. D., Grinband, J., Agin-Liebes, G., Kinslow, C. J., Zeifman, R. J., Bogenschutz, M. P., Griffiths, R. R., & Ross, S. (2024) · Nature Mental Health · doi:10.1038/s44220-024-00331-0 · Cited by 10 · see citing works
“In such instances, therapy is often combined with pharmacological treatments, including antidepressants, stimulants and ketamine 10 .”
Ma, D. D. F., Liu, Z., Au, K., Tran, M. J., Artuz, C. M., Greenwood, M. J., Bilmon, I., & Kliman, D. S. (2024) · Journal of Clinical Oncology · doi:10.1200/jco.24.00333 · Cited by 11 · see citing works
Randall, J., Gordon, A., Boyle, C., Curran, D. W., Hassel, H., Russell, J., Tweeten, B., Walker, K., & Zoll, K. (2025) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2025.03.013 · Cited by 10 · see citing works
Wu, P., Qian, M., Chen, X., Zhu, M., & Liu, J. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112107 · Cited by 10 · see citing works
Štánerová, E., Zelenayová, V., & Rajčáni, J. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112312 · Cited by 18 · see citing works
Risk of Late-Onset Depression in Long-Term Survivors of Breast, Prostate, and Colorectal Cancer
Taylor, M. A., Westvold, S. J., Long, J. B., Hyslop, T., Silber, A. L. M., Forman, R., Yasin, F., Kwaramba, T., Wang, S.-Y., Leapman, M., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.44812 · Cited by 10 · see citing works
Emotional distress and future healthcare utilization in oncology populations: A systematic review
Kirsch, J. L., Roche, A. I., Bronars, C. A., Donovan, K. A., Hassett, L. C., & Ehlers, S. L. (2024) · Psycho-Oncology · doi:10.1002/pon.6322 · Cited by 9 · see citing works
Associations between Symptoms and Exercise Barriers in Breast Cancer Survivors
Scott, H., Brown, N. I., Schleicher, E. A., Oster, R. A., McAuley, E., Courneya, K. S., Anton, P. M., Ehlers, D. K., Phillips, S. M., & Rogers, L. Q. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12206531 · Cited by 10 · see citing works
“…on mood as documented in a recent consensus statement by the American College of Sports Medicine, it is not surprising that the American Society of Clinical Oncology guidelines for treatment of mood disorders in cancer survivors include exercise as a non-pharmacologic treatment modality [7,37].”
BackgroundGao, W., Zhang, Q., Zhang, L., Xu, M., Zhu, Y., & Han, J. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102798 · Cited by 9 · see citing works
Association Between Body Image and Quality of Life of Women Who Underwent Breast Cancer Surgery
Battistello, C. Z., Remor, E., Costa, Í. M., et al. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22071114 · Cited by 8 · see citing works
“Patients who do not have access to first-line treatment prefer pharmacotherapy, and those who previously responded well to pharmacotherapy may benefit from a pharmacologic regimen for depression or anxiety according to guidelines [22,23].”
Colon Cancer Survivorship in Patients Who Have Received Adjuvant Chemotherapy
Kesireddy, M., & Tenner, L. L. (2023) · Clinical Colorectal Cancer · doi:10.1016/j.clcc.2023.07.001 · Cited by 8 · see citing works
Integrative Oncology Approaches to Reduce Recurrence of Disease and Improve Survival
Powers-James, C., Morse, M. B., Narayanan, S., Ramondetta, L., Lopez, G., Wagner, R., & Cohen, L. (2024) · Current Oncology Reports · doi:10.1007/s11912-023-01467-5 · Cited by 8 · see citing works
“In recent years, both the Society for Integrative Oncology and the American Society of Clinical Oncology [68, 69] have recognized the importance of managing depression and anxiety in oncology patients and developed a guideline.”
Chen, Y., Chen, X., Li, L., Li, Y., Yan, Q., & Hu, X. (2024) · Cancer Nursing · doi:10.1097/ncc.0000000000001430 · Cited by 11 · see citing works
Booker, R., Sawatzky, R. G., Sinnarajah, A., Qi, S., Link, C., Watson, L. C., & Stajduhar, K. (2025) · Current Oncology · doi:10.3390/curroncol32020062 · Cited by 7 · see citing works
“The American Society of Clinical Oncology guideline for the management of anxiety and depression in cancer survivors calls for a stepped approach that includes education, psychotherapy, and pharmacotherapy tailored to the individual patient’s needs [116].”
Trajectory of Global Mental Health and Global Physical Health in Breast Cancer Survivorship
Pritzl, S. L., Vierkant, R. A., Ruddy, K. J., Stan, D. L., Larson, N. L., Olson, J. E., Couch, F. J., Higgins, A. S., & Ehlers, S. L. (2025) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2024.7353 · Cited by 7 · see citing works
Wu, P., Chen, X.-X., Wang, S., Chen, X.-X., & Liu, J. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119630 · Cited by 9 · see citing works
Abdalla, T., Singh, G. K., Roudbaneh, S. P., Serwaa, D., & Peate, M. (2025) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djaf153 · Cited by 13 · see citing works
Xiao, Y., Zhao, Z., Su, C., Li, J., & Liu, J. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07074-x · Cited by 7 · see citing works
“People with high education levels may be more likely to obtain stronger self-adaptability and superior social resources, thus helping them to get rid of depression more easily [35].”
Ge, M., Zhang, W., Zhang, W., Zhang, Z., Zeng, X., Deng, L., Wen, M., Lu, X., Shen, X., Li, Z., et al. (2025) · Journal of Advanced Research · doi:10.1016/j.jare.2025.11.001 · Cited by 7 · see citing works
“Although psychosocial stressors have been shown to influence tumor progression in both clinical observations and experimental data, the biological mechanisms underlying depression-related tumors and potential strategies to counteract treatment-related side effects remain unclear[163–165].”
Liou, K. T., Bradt, J., Currier, M. B., Baser, R. E., Panageas, K., MacLeod, J., Walker, D. A. H., Li, S. Q., López, A. M., McConnell, K., et al. (2026) · Journal of Clinical Oncology · doi:10.1200/jco-25-00726 · Cited by 8 · see citing works
“14 However, some patients are unable to complete a full treatment course 15,16 or achieve clinically meaningful improvements.”
Palliative Care in Neuro-oncology: an Update
Rhee, J. Y., Strander, S. M., Podgurski, A. F., Chiu, D., Brizzi, K. T., & Forst, D. A. (2023) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-023-01301-2 · Cited by 8 · see citing works
“…recent American Society of Clinical Oncology (ASCO) practice guideline regarding the management of depression and anxiety in adult cancer survivors [41] recommends providing the most effective and least resource-intensive intervention based on symptom severity and offering all patients education…”
BackgroundDepression, non-medical pain prescriptions, and suicidal behavior in cancer survivors
Mwobobia, J. M., White, M., Osazuwa‐Peters, O. L., Boakye, E. A., Abouelella, D. K., Barnes, J. M., Viet, C. T., Ramos, K., Corbett, C. M., & Osazuwa‐Peters, N. (2025) · Journal of Cancer Survivorship · doi:10.1007/s11764-024-01740-x · Cited by 7 · see citing works
“Unfortunately, while depression is significantly more common in cancer survivors compared to the general population [38], it may be insufficiently screened and treated [39], increasing risks of adverse suicidal outcomes.”
Vanlaer, N., Dirven, I., Neyns, B., & Rogiers, A. (2024) · Cancers · doi:10.3390/cancers16091638 · Cited by 6 · see citing works
“These results underscore the high prevalence of FCR in advanced-stage cancer survivors and, subsequently, the need for structural screening throughout the survivorship trajectory, which accords with the guidelines of the American Society of Clinical Oncology on anxiety and depression [30].”
ResultYoung lung cancer: from diagnosis to survivorship
Florez, N., Kiel, L., Kaufman, R. A., LoPiccolo, J., Ricciuti, B., Morabito, A. S., Fakorede, O., Mantz, C., Olazagasti, C., Swami, N. S., et al. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1570143 · Cited by 6 · see citing works
“Early and accurate identi fi cation of emotional issues, achieved through routine administration of validated tools to detect emotional distress, is crucial (161, 162).”
Functional resilience and overall survival in adults treated for advanced non-small-cell lung cancer
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Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach
Nuseibeh, B. Z., Johns, S. A., Shih, P. C., Lewis, G. F., Gowan, T. M., & Jordan, E. J. (2024) · JMIR Formative Research · doi:10.2196/59426 · Cited by 5 · see citing works
For the Long Haul: Management of Long-Term Survivors after Melanoma Systemic Therapy
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“Per ASCO guidelines, assessing for anxiety and depression using screening tools such as the PHQ-9 and GAD-7 is an integral part of survivorship care [67].”
Sharma, S., Dahne, J., Gallicchio, L. M., Mollica, M. A., Tonorezos, E. S., Petrillo, L. A., Nasso, S. F., Ross, B., & Graboyes, E. M. (2025) · JCO Oncology Practice · doi:10.1200/op-25-00872 · Cited by 5 · see citing works
Yeoh, S. A., Bowie, A., Windsor, T. D., Russell, H., Kumar, S., & Beatty, L. (2026) · Cancer Medicine · doi:10.1002/cam4.71368 · Cited by 7 · see citing works
“A large body of evidence has demonstrated the effectiveness of psychosocial interventions tailored to cancer survivors to address the negative impacts [5–7].”
Zachariae, R. H., Christiansen, P., Amidi, A., Wu, L. M., Ventzel, L., Tauber, N. M., von Heymann, A., Rafn, B. S., Fassov, J., Juul, T., et al. (2024) · Acta Oncologica · doi:10.2340/1651-226x.2024.40787 · Cited by 5 · see citing works
“For patients with moderate to severe symptoms of depression, the treatments recommended by international guidelines include cognitive behavioral therapy (CBT), behavioral activation (BA), and mindfulness-based therapy (MBT) [3].”
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“The diagnoses of diabetes or breast cancer have independently been associated with anxiety and depression [54–56].”
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Chronic stress in cancer development and progression
Niu, X., Wu, T. H., Zeng, L., Wang, F., Lv, W., Zhang, L., & Zhou, F. (2025) · 中国科学通报：英文版 · doi:10.1016/j.scib.2025.09.034 · Cited by 6 · see citing works
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New highlights in cancer and depression multimorbidity: a scoping systematic review
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“Treatment decisions must prioritize the effective management of depressive symptoms while maintaining vigilance for potential pharmacologic interactions with chemotherapeutic and targeted agents (158, 159).”
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“However, pharmacotherapy can still be helpful in patients who prefer it or don’t have access to first-line treatment such as cognitive behavior therapy, behavioral activation, mindfulness-based stress reduction, physical activity, or psychosocial interventions [75].”
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“Clinical guidelines recognize the prevalence and importance of psychological distress in breast cancer patients, and it is recommended that patients be routinely screened and offered pharmacologic and non-pharmacologic supports in addition to traditional care [39].”
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Improving mental health care among patients with cancer in China
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Diagnosing and Treating Blastic Plasmacytoid Dendritic Cell Neoplasm in a Resource-Limited Setting
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Survivors of Oncological Disease: Experience and Satisfaction with National Health Care and Service
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“In the long term, anxiety is positively correlated with cancer mortality rates [9].”
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Hypnosis in the self-regulation of feeling states
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“6 However, the individual treatment model is resource intensive, requiring ‡ 16 h of therapist time per patient.”
- Authors
- Andersen, B. L., Lacchetti, C., Ashing, K., Berek, J. S., Berman, B. S., Bolte, S., Dizon, D. S., Given, B., Nekhlyudov, L., Pirl, W., Stanton, A. L., & Rowland, J. H.
- Affiliations
- The Ohio State University (US)
- American Society of Clinical Oncology (US)
- City Of Hope National Medical Center (US)
- Stanford Medicine (US)
- Florida Cancer Specialists, West Palm Beach, FL
- Inova Health Foundation, Falls Church, VA
- Brown University (US)
- Michigan State University (US)
- Brigham and Women's Hospital (US)
- Dana-Farber Cancer Institute (US)
- University of California, Los Angeles (US)
- Smith Center for Healing and the Arts (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2023-06-20
- Volume
- 41
- Issue
- 18
- Pages
- 3426-3453
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W4366448658
- Cited by
- 318
- References
- 155
- Citations by year
- 2026: 128 · 2025: 101 · 2024: 75 · 2023: 13 · 2021: 1
- FWCI
- 38.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Society of Clinical Oncology
- Partenariat Canadien Contre Le Cancer
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- cancer survivors, anxiety, depression, psychosocial interventions, mindfulness-based stress reduction, cognitive behavioral therapy, behavioral activation, acceptance and commitment therapy, interpersonal psychotherapy, physical activity, stepped care, pharmacotherapy, ethnic minorities, survivorship care
- MeSH terms
- Adult, Anxiety, Depression, Ethnicity, Humans, Minority Groups, Neoplasms, Survivors, Acceptance and Commitment Therapy
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