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

In the paper

“However, neither of these trials included participants above a threshold for depressive symptoms.”

What the sources say

• Disputed

  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.

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

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [39] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [29] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [40] sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [41] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [16] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [17] source
• Partly supported

  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)

  cites [18] sourceExperimental — accuracy not yet measured

In the paper

“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]”

What the sources say

• ?Not checked — no full text of the sourcecites [32] source
• Partly supported

  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)

  cites [33] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [34] source

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [23] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [24] source
• ?Not checked — no full text of the sourcecites [25] source

In the paper

“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”

What the sources say

• ?Could not verify

  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)

  cites [16] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [17] source
• Partly supported

  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)

  cites [18] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [26] source
• Supported

  In adult cancer patients, the Results (section 3.3) show that those with an anxiety diagnosis had higher odds of emergency-department visits and hospitalization than those with neither anxiety nor depression. Section 3.5 reports significantly higher annual healthcare costs for the anxiety-only group. (LLM, conf=0.90)

  cites [27] source
• ?Not checked — no full text of the sourcecites [28] source

In the paper

“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]”

What the sources say

• Partly supported

  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)

  cites [10] sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [11] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [12] source

In the paper

“in the long term, data show its relationship to cancer mortality.13”

What the sources say

• Partly supported

  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)

  cites [13] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [16] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [17] source
• Partly supported

  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)

  cites [18] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Supported

  The Introduction reports that baseline depression assessments have been associated with shortened survival in cancer patients. The Abstract reports that, in patients with stage-IV non-small cell lung cancer, depressive-symptom trajectories from diagnosis through 24 months were significantly associated with survival after adjustment for covariates. This supports the attributed association, within the population and follow-up period studied. (LLM, conf=0.88)

  cites [16] source
• ?Not checked — no full text of the sourcecites [17] source
• Partly supported

  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)

  cites [18] sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites [54] sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [60] Uphoff E, 2020, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [61] source
• Partly supported

  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)

  cites [120] sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [121] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [122] source

In the paper

“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”

What the sources say

• Supported

  The Methods (Procedure; page unavailable) describe random assignment to home-based walking exercise or usual care, with the usual-care group receiving the walking booklet only after the study. The Results (Intervention effects on anxiety, depression and cancer-related symptoms; page unavailable) report statistically significant group-by-time reductions in both anxiety and depression. This paper supports the finding for one of the two RCTs cited in the sentence. (LLM, conf=0.91)

  cites [71] source
• Supported

  The Results report statistically significant reductions in both depression and anxiety for the BEAT Cancer group compared with usual care. The Methods describe this as a randomized trial and state that usual-care participants received printed materials but no physical-activity counseling or instructions beyond those materials. The paper supports the finding for this RCT; the second RCT is covered by the other citation. (LLM, conf=0.92)

  cites [95] source

In the paper

“Also, head-to-head comparisons of selective serotonin reuptake inhibitors versus tricyclic antidepressants showed no difference.57”

What the sources say

• Supported

  The review’s Main results report that head-to-head comparisons of SSRIs and TCAs showed no difference between the classes. The evidence was rated very low certainty, so this means no statistically significant difference was found, not that the treatments were proven equivalent. (LLM, conf=0.94)

  cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev source

In the paper

“While evidence from other meta-analyses support the benefit of exercise for depression, no significant benefit was found for anxiety.47,49”

What the sources say

• Supported

  The Results (Subscale depression) report a small pooled benefit for depression across six trials, though the evidence is low-certainty. The results also find no evidence of a difference for anxiety. These findings concern adults with haematological malignancies. (LLM, conf=0.90)

  cites [47] Bergenthal N, 2014, Cochrane Database Syst Rev source
• ?Not checked — no full text of the sourcecites [49] source

In the paper

“Interventions for managing anxiety disorders or anxiety symptoms were evaluated in only three RCTs identified in the updated literature search.73,76,85”

What the sources say

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

  The citation identifies this paper as one of the RCTs evaluating an intervention for anxiety symptoms. The Discussion describes it as a randomized trial of a CBT mobile app for anxiety in patients with incurable cancer. The count of three RCTs comes from the citing authors’ updated search, not from this individual trial. (LLM, conf=0.90)

  cites [76] source
• ?Not checked — no full text of the sourcecites [85] source

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“The other trial 93 with unscreened patients found reductions in depressive symptoms with individual supportive psychotherapy compared with TAU.”

What the sources say

• Supported

  The Methods (Participants; page unavailable) list no depression or distress threshold for enrollment, so the trial did not select patients on that basis, although it assessed depression at baseline. The Methods (Trial Conditions) describe CALM psychotherapy sessions, and the Results report less-severe depressive symptoms with CALM than with usual care at both 3 and 6 months. (LLM, conf=0.91)

  cites [93] source

In the paper

“While evidence from other meta-analyses support the benefit of exercise for depression, no significant benefit was found for anxiety.47,49”

What the sources say

• Supported

  The “Subscale anxiety” results report no evidence of a difference between exercise and standard treatment across six trials (445 participants). The review rates this evidence as very low certainty, so the finding is an absence of a statistically significant benefit, not proof that exercise has no effect. (LLM, conf=0.93)

  cites [47] Bergenthal N, 2014, Cochrane Database Syst Rev source
• ?Not checked — no full text of the sourcecites [49] source

In the paper

“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”

What the sources say

• Supported

  The Abstract Methods describe random allocation of women treated for breast cancer to a six-month exercise and healthy-eating program plus usual care or usual care alone. The Abstract Results report significantly fewer depressive symptoms in the intervention group at six months (P = 0.004). (LLM, conf=0.95)

  cites [96] source

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [58] Ream E, 2020, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [56] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [35] sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Supported

  The Main results report no statistically significant difference between antidepressants and placebo for depressive symptoms at 6–12 weeks, with very low-certainty evidence. The Psychiatric diagnosis subgroup analysis says the primary outcome also remained nonsignificant among people with major depressive disorder. (LLM, conf=0.93)

  cites [57] Ostuzzi G, 2018, Cochrane Database Syst Rev source

In the paper

“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]”

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
• ?Could not verify

  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)

  cites [154] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [155] source
• ?Not checked — no full text of the sourcecites [156] source
• ?Not checked — no full text of the sourcecites [157] source

In the paper

“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]”

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
• ?Not checked — no full text of the sourcecites [159] source
• Partly supported

  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)

  cites [160] sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [161] Schefter A, 2022, Cancer Rep sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [162] source
• ?Not checked — no full text of the sourcecites [163] source

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites [137] sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [138] sourceExperimental — accuracy not yet measured

In the paper

“Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety.”

In the paper

“Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent.”

In the paper

“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.”

In the paper

“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.”

In the paper

“Current evidence supports that the recommended treatment interventions for depression and anxiety are effective therapeutic options.”

In the paper

“CBT was also found to be superior to bright light therapy.74”

What the sources say

• ?Not checked — no full text of the sourcecites [74] source

In the paper

“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.”

In the paper

“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”

In the paper

“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).”

In the paper

“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).”

In the paper

“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).”

In the paper

“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.”

In the paper

“In studies with high-quality ratings, RCT evidence supports the benefit of CBT.”

In the paper

“For the nonpharmacologic RCTs (39 studies), only four (10%) trials had low risk of bias across all domains.96,97,104,107”

In the paper

“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.”

In the paper

“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.”

In the paper

“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).”

In the paper

“Most non-US studies did not provide ethnic and/or racial characteristics of the participants.”

In the paper

“For the 55 nonpharmacologic studies, the intervention arm was most often compared with a treatment-as-usual (TAU) control (36 studies).”

In the paper

“For RCTs, overall risk of bias ranged from low to high (Data Supplement).”

In the paper

“In studies using screening, all patients were described as being in the postoncologic treatment phase.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [102] source

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [99] source
• ?Not checked — no full text of the sourcecites [107] source
• ?Not checked — no full text of the sourcecites [102] source

In the paper

“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”

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

“However, this early antidepressant response in terminally ill patients with cancer was associated with an increased risk of nervous system adverse events.”

What the sources say

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

In the paper

“Comparative effectiveness studies indicated similar effects across different models of psychological interventions.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [85] source

In the paper

“This was also the case if additional therapies were included, such as second-wave therapies (MBSR, acceptance, and commitment therapy).50”

What the sources say

• ?Not checked — no full text of the sourcecites [50] source

In the paper

“many studies (one third) began with baseline group differences”

In the paper

“Excluding the studies of education only, many of the remaining trials are single examples of experimenterdeveloped treatments.”

In the paper

“patients with the latter were more often excluded from trial participation.”

In the paper

“Psychological screening for trial entry was rare”

In the paper

“95% of the reviewed studies focused on depression alone or with comorbid anxiety.”

In the paper

“The Ren study 91 is notable for showing significant effects for CBT in comparison with both attention control and TAU arms.”

In the paper

“with the majority of study participants (60%-70%) likely having no or few symptoms of generalized anxiety or major depression”

In the paper

“Relevant to cost of treatment, evidence is also confirmatory for multiple modes of delivery including by app, virtually, telephone, and others.”

In the paper

“posttreatment follow-up data were provided in eight studies (36%) to test for sustained effects of interventions.”

In the paper

“Three RCTs were conducted in palliative care settings or with palliative care specialists.”

In the paper

“Analyses showed worsened outcomes for those in the enhanced condition.”

In the paper

“This contrasts with the limited, low-quality evidence for pharmacotherapies.”

In the paper

“there is no evidence from RCTs to suggest such efforts would impact anxiety or depressive symptoms.”

In the paper

“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.”

In the paper

“Statistically significant benefits were seen for various management strategies across the comorbid symptoms.”

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

“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.”

In the paper

“Other than the latter, the most common source of bias in the RCTs was attrition.”

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

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [4] source

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [4] source

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [114] source

In the paper

“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”

What the sources say

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

In the paper

“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.”

In the paper

“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]”

What the sources say

• ?Not matched

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

  cites [117][118][119]

In the paper

“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]”

What the sources say

• ?Not matched

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

  cites [125][126][127][128][129]

In the paper

“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.”

In the paper

“The evidence is not compelling”

In the paper

“contrasting with meta-analyses showing stronger posttreatment effects when coaching is used.132”

What the sources say

• ?Not checked — no full text of the sourcecites [132] source

In the paper

“Anxiety and depressive symptoms and disorders are not randomly distributed.”

In the paper

“Disparities in survivors' mental health remain even when sociodemographic and psychosocial factors are considered.153,155”

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 [155] source

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [136] source

In the paper

“it is commonly comorbid with others, primarily mood disorders or other anxiety disorders”

What the sources say

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

In the paper

“A meta-analysis by Manea et al also supports the .8 cutoff score.”

What the sources say

• ?Not matched

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

  cites Manea et al

In the paper

“it is the most prevalent of all anxiety disorders”

What the sources say

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

In the paper

“Whereas cancer worries may be common for many, GAD worry or fear may be disproportionate to actual cancer-related risk”

What the sources say

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