Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Explain the importance of addressing mood or anxiety disorders among adults with cancer.
- Review key recommendations made in the American Society of Clinical Oncology’s 2014 guideline adaptation on managing anxiety and depressive symptoms in adults with cancer.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwjuly6. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Complete the Post Test(click to view)
Studies have shown that distress is common among people with cancer, but the types and causes vary. “Research shows that 20% to 25% of newly diagnosed cancer patients and/or survivors are at risk for mood or anxiety disorders, but these problems can go undetected unless they’re considered to be a possibility and then evaluated,” says Barbara L. Andersen, PhD. The days surrounding the diagnosis and initiation of cancer treatment tend to be the most stressful for patients. Failing to address psychological needs, regardless of when they arise, can increase risks for stress and anxiety as well as depressive symptoms. It can also reduce quality of life, increase risks for adverse effects, and lead to more physical symptoms.
Treatment for anxiety or depression is often successful and has the potential to reduce the risk of cancer recurrence or disease-related death. “Clinicians may not be able to prevent some of the chronic or late medical effects of cancer, but we can play a vital role in preventing or reducing the emotional fall-out at diagnosis and thereafter,” Dr. Andersen says. If symptoms of anxiety or depression can be recognized and treated effectively, there is a chance that clinicians can reduce the human cost of cancer.
Recently, the American Society of Clinical Oncology (ASCO) released new guidelines to help manage anxiety and depressive symptoms in adults with cancer. The document is a clinical practice guideline adaptation that incorporates recommendations that have been set forth from other organizations. The guidelines detail optimal strategies for screening and assessing patients and offer options for psychological and supportive care interventions for those experiencing symptoms of depression and/or anxiety.
Vigilance for Screenings & Assessments
According to the ASCO guidelines, all patients with cancer should be evaluated for symptoms of depression and anxiety periodically across the trajectory of care (Table 1). Assessment should be performed using validated, published measures, and procedures. “Depending on levels of symptoms that are reported, different treatment pathways are suggested,” says Dr. Andersen. “A strong doctor–patient rapport can help when assessing patients’ depression and anxiety and determine the most appropriate treatment strategy. We must also regularly reassess patients’ mental health status to determine the efficacy of the first course of treatment for anxiety or depression. If treatments are ineffective, steps can then be taken in a timely fashion to find alternative treatments or modifications.”
The ASCO guidelines note that healthcare providers should first identify the available resources in their institution and community for treating depression and anxiety symptoms. The availability and accessibility of supportive care services for all patients with cancer are important in efforts to prevent or reduce the severity of symptoms. “Healthcare providers are busy and may not appreciate the impact of depression or anxiety disorders,” Dr. Andersen says. Research shows that psychiatric disorders are more prevalent among patients with cancer than for those with other chronic illnesses. The guidelines emphasize greater vigilance in considering and evaluating depression and anxiety symptoms in patients with cancer.
For many survivors, the experience of cancer does not end with the conclusion of therapy. Survivors oftentimes have lingering issues that can affect all aspects of their lives, including physical, psychological, social, existential, and financial worries. “This can culminate in added psychological distress,” says Dr. Andersen. In addition, cancer survivors can also experience other chronic comorbid conditions, such as heart disease, diabetes, or age-related problems, like arthritis or osteoporosis. These comorbidities can further impact patients’ emotional well-being and should be addressed in follow-up care.
When patients complete cancer therapy, many are transitioned to a primary care physician or other providers for follow-up. This transition, however, may be difficult for some patients. Moreover, survivors with depression or anxiety may not follow through on referrals or comply with treatment recommendations (Table 2). To overcome this hurdle, clinicians are recommended to provide patients with a survivorship care plan that is personalized. “These plans should offer information about treatment and follow-up for patients as well as any new providers,” Dr. Andersen says. “For patients, these plans should identify providers who will be responsible for specific aspects of their physical and emotional healthcare needs in the near future.”
Dr. Andersen notes that cancer survivors are still vulnerable to distress later in life. “We have to remember that these patients can feel the effects emotionally, interpersonally, and financially over time,” she says. “Clinicians must be vigilant about addressing depressive and anxiety symptoms throughout the course of care. The guidelines from ASCO can help us recognize and hopefully eliminate gaps in care for these patients.”
Readings & Resources (click to view)
Andersen BL, DeRubeis RJ, Berman BS, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Onc. 2014;32:1605-1619. Available at: http://jco.ascopubs.org/content/early/2014/04/09/JCO.2013.52.4611.abstract.
Howell D, Keller-Olaman S, Oliver T, et al. A pan-Canadian practice guideline: Screening, assessment and care of psychosocial distress (depression, anxiety) in adults with cancer. Canadian Partnership Against Cancer (Cancer Journey Action Group) and the Canadian Association of Psychosocial Oncology, 2010. Available at: www.capo.ca/pdf/ENGLISH_Depression_Anxiety_Guidelines_for_Posting_Sept2011.pdf.
Ganz PA, Earle CC, Goodwin PJ. Journal of Clinical Oncology update on progress in cancer survivorship care and research. J Clin Oncol. 2012;30:3655-3656.
Thekkumpurath P, Walker J, Butcher I, et al. Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer. 2011;117:218-227.
Chida Y, Hamer M, Wardle J, et al. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466-475.