Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [103] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [105] source
• ?Not checked — no full text of the sourcecites [69] source
• Disputed

  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.

  cites [98] sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Disputed

  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.

  cites [54] sourceExperimental — accuracy not yet measured

In the paper

“Depressive symptoms are elevated for those with advanced disease stage and/or significant symptom burden.14,15”

What the sources say

• Partly supported

  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)

  cites [14] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [15] source

In the paper

“As is the case for those without cancer, depression and anxiety usually co-occur.30”

What the sources say

• ?Could not verify

  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)

  cites [30] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [45] source
• Partly supported

  The Abstract (page not available) describes Cochrane guidance on risk-of-bias assessment, including the RoB 2 and ROBINS-I tools. It does not mention GRADE or describe assessing the quality of evidence for each outcome using the combined process claimed here. (LLM, conf=0.82)

  cites [46] Cumpston M, 2019, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“In studies not screening patients for enrollment, CBT plus BT (relaxation) 77,100 and education plus self-care 123 significantly improved depression.”

What the sources say

• Partly supported

  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)

  cites [77] sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [100] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [123] source

In the paper

“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”

What the sources say

• Supported

  The Results state that women who completed the long-term follow-up were older, had lower depressive symptoms at baseline, and had better overall quality of life at baseline than those who did not. The Discussion describes these baseline differences as occurring at the time of diagnosis and refers to greater well-being. (LLM, conf=0.95)

  cites [101] source

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [73] source
• Supported

  The Participants section describes patients with stage IV or metastatic incurable cancer, and the Discussion reports no significant overall outcome differences between the CBT mobile app and health education groups. The citation numbered 76 supports the mobile-app portion of the sentence, not the separately cited gynecologic-surgery intervention. The Discussion also notes a benefit for patients with severe baseline anxiety. (LLM, conf=0.90)

  cites [76] source

In the paper

“Moreover, a self-report bias may have played a role in the measures collected.101”

What the sources say

• Supported

  The Discussion’s Strengths and Limitations section explicitly states that self-report bias may have played a role in the measures collected. This matches the citing sentence’s qualified claim. (LLM, conf=0.95)

  cites [101] source

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [56] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [62] source
• ?Not checked — no full text of the sourcecites [64] source

In the paper

“Although evidence of longterm benefit has been reported, 101 the generalizability of this finding is limited.”

What the sources say

• Supported

  The Discussion reports better quality of life and fewer depressive symptoms 8–15 years after the intervention. Its Strengths and Limitations section explicitly says generalizability is limited by the study setting, location, early-stage sample, and differences between follow-up participants and nonparticipants. (LLM, conf=0.94)

  cites [101] source

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites [98] sourceExperimental — accuracy not yet measured

In the paper

“Trials of problem-solving therapies alone, 103 or behavior change programs 72 did not show a statistically significant benefit for depression.”

What the sources say

• Partly supported

  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)

  cites [103] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [72] source

In the paper

“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”

What the sources say

• Supported

  The paper discusses 2014 recommendations for implementing distress screening and reports subsequent progress in adopting screening guidelines. Its Conclusions state that adoption has increased but that only about a quarter of surveyed institutions screen all patients, with screening procedures still lacking standardisation. Page numbers are unavailable in our copy. (LLM, conf=0.87)

  cites [134] source
• ?Not checked — no full text of the sourcecites [135] source

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [146] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [143] sourceExperimental — accuracy not yet measured
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [144] Potter AL, 2023, JAMA Oncol

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [142] sourceExperimental — accuracy not yet measured

In the paper

“Accrual of study participants occurred during active oncologic treatment in 20% of all included studies and during the post-treatment phase in 41%.”

In the paper

“The duration of the interventions in the nonpharmacologic studies ranged from a single session to 24 sessions spanning 12 months.”

In the paper

“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.”

In the paper

“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).”

In the paper

“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.”

In the paper

“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.”

In the paper

“Follow-up was ,3 months in seven studies and extended to 3 months or more in 20 studies.”

In the paper

“The time elapsed since cancer diagnosis ranged from less than a month to 5 years.”

In the paper

“Unfortunately, few trials explored the causes of missingness or contrasted patients with complete versus incomplete (missing) data.”

In the paper

“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).”

In the paper

“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.”

In the paper

“Sample sizes ranged from 62 to 500 in the RCTs using screening and 74 to 2,140 in RCTs with unscreened participants.”

In the paper

“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”

In the paper

“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).”

In the paper

“The majority of the interventions were delivered face-to-face, although 12 studies involved remote options including telephone or virtual sessions.”

In the paper

“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.”

In the paper

“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”

In the paper

“Interventions for managing both depression and anxiety were evaluated in 12 meta-analyses and one systematic review.”

In the paper

“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.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [89] source

In the paper

“In 11 of the meta-analyses, CBT was evaluated and all found CBT to result in significant reductions in depressive and anxiety symptoms.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [66] source

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [115] source

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [99] source
• ?Not checked — no full text of the sourcecites [107] source

In the paper

“Finally, Ho 79 reported null effects for both supportive expressive therapy and a mind-body-spirit intervention compared with an unstructured peer support group.”

In the paper

“The Data Supplement outlines two studies 89,108 reporting positive effects at day 3, a finding of unknown consequence”

In the paper

“many of the interventions reviewed were delivered after primary oncologic treatments were completed.”

In the paper

“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.”

In the paper

“Some components of the tested treatments may have empirical support (eg, problem solving), whereas other components do not (eg, diary keeping).”

In the paper

“The one noninferiority trial comparing internet-delivered CBT without coaching versus with coaching 75 showed no significant differences and improvements occurred for both groups”

In the paper

“As for management, our systematic review shows CBT and BA achieve robust effects on symptom reduction.”

In the paper

“First, several studies included assessments during the course of treatment (eg, Zhao 111 )”

In the paper

“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.”

In the paper

“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.”

In the paper

“with other studies having sample sizes just within the cutoff for systematic review inclusion (N 5 40).”

In the paper

“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]”

What the sources say

• ?Not checked — no full text of the sourcecites [19] source
• ?Not checked — no full text of the sourcecites [20] source
• ?Not checked — no full text of the sourcecites [21] source

In the paper

“In studies using diagnostic interviews, the prevalence is approximately 10%.37”

What the sources say

• ?Not checked — no full text of the sourcecites [37] source

In the paper

“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.”

In the paper

“Notably, Arch et al 19 found that 31% of patients with cancer with an anxiety disorder also had major depressive disorder (MDD).”

What the sources say

• ?Not checked — no full text of the sourcecites [19] source

In the paper

“stress, depression, and anxiety are prevalent and occur throughout the survivorship trajectory.8,9”

What the sources say

• ?Not checked — no full text of the sourcecites [8] source
• ?Not checked — no full text of the sourcecites [9] source

In the paper

“Again, a conservative estimate (10%) of the number of new cases having a comorbid anxiety disorder would be 200,000 individuals.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [36] source

In the paper

“Systematic reviews and metaanalyses were evaluated using the assessment of multiple systematic reviews rating”

In the paper

“The Expert Panel was assembled in accordance with ASCO's Conflict of Interest Policy Implementation for Clinical Practice Guidelines (”

In the paper

“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.”

In the paper

“Study quality was formally assessed for all 61 studies identified.”

In the paper

“All ASCO guidelines are ultimately reviewed and approved by the Expert Panel and the ASCO Evidence Based Medicine Committee before publication.”

In the paper

“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.”

In the paper

“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”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [115] source

In the paper

“Overall, the diversity in the included studies precluded a quantitative analysis and, as such, a qualitative review was performed.”

In the paper

“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.”

In the paper

“All funding for the administration of the project was provided by ASCO.”

In the paper

“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.”

In the paper

“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.”

In the paper

“Many trials had small sample sizes and/or high attrition rates impacting statistical power and lowering confidence in the findings.”

In the paper

“Data missingness elevates the risk of bias as the listed circumstances are nonrandom, and missingness is made worse by not determining its origins.”

In the paper

“In addition to efficacy, other benefits of a stepped care model are opportunity for tailoring of patient care and optimized resource allocation.116”

What the sources say

• ?Not checked — no full text of the sourcecites [116] source

In the paper

“In 2023, an estimated two million new cancer cases will be diagnosed.31”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [31] American Cancer Society, 2022

In the paper

“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.”

In the paper

“Also, the detection of differences between active treatments demands large sample sizes, as the experimental question is degree of improvement, not improvement per se.”

In the paper

“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.”

In the paper

“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.”

In the paper

“Each included publication was assessed for methodological quality by one methodologist.”

In the paper

“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:”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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

In the paper

“However, the historical weight of evidence for CBT and BA is most compelling.”

In the paper

“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.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites Singh et al 59

In the paper

“In particular, psychosocial interventions, stress reduction strategies, and a combination of CBT, hypnosis, and support are effective over standard care.”

In the paper

“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.”

In the paper

“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.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites McGettigan et al 55

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [66] source
• ?Not checked — no full text of the sourcecites [86] source

In the paper

“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).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites Table 3

In the paper

“In RCTs, screening of patients is essential (used in only one third of studies) and has the potential benefit of reducing sample size.”

In the paper

“Data loss threatens the reliability and validity of findings.”

In the paper

“In RCTs, screening of patients is essential (used in only one third of studies) and has the potential benefit of reducing sample size.”

In the paper

“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.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [148] source

In the paper

“As noted earlier, high mortality may be anticipated in trials accruing patients with advanced disease and/or in the palliative care setting.”

In the paper

“These data align with earlier trials showing negative effects for peer support conditions, 133 countering assumptions of peer support being uniformly beneficial.”

What the sources say

• ?Not checked — no full text of the sourcecites [133] source

In the paper

“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.”

In the paper

“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]”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [149] US Cancer Statistics Working Group, 2015
• ?Not matched

  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
• ?Not checked — no full text of the sourcecites [151] Mead H, 2008
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [152] American Cancer Society, 2016

In the paper

“a circumstance less likely when randomizing within strata, as variables potentially correlated with the outcome can reduce nuisance subject variance.”

In the paper

“Such approaches limit the interpretation of the findings, and hinder replication by other investigators and the accumulation of knowledge supporting one treatment over another.”

In the paper

“Finding significant pre-treatment to post-treatment effects is necessary but often not sufficient to confirm treatment effectiveness with depressed or anxious patients.”

In the paper

“The pathognomic GAD symptom, ie, multiple excessive worries, may present as concerns or fears.”

What the sources say

• ?Not checked — no full text of the sourcecites [7] source

In the paper

“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.”

In the paper

“Importantly, an individual with GAD has worries about a range of other, noncancer topics and areas of his/her life.”

What the sources say

• ?Not checked — no full text of the sourcecites [7] source

In the paper

“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”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [153] American Association for Cancer Research, 2022
• ?Not checked — no full text of the sourcecites [158] source

In the paper

“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.”

In the paper

“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,”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites CAPO and the Canadian Partnership Against Cancer guideline

In the paper

“Thus, it is the patient's endorsement of multiple symptoms that will define the need for services for moderate/ severe to severe symptomatology.”

In the paper

“Patients with GAD do not necessarily present with symptoms of anxiety, per se.”

What the sources say

• ?Not checked — no full text of the sourcecites [7] source

In the paper

“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.”

In the paper

“The draft recommendations were released to the public for open comment from September 19 through October 3, 2022.Response categories of”

In the paper

“Such changes also weaken the predictive validity of the score and the clarity of the cutoff scores.”