Guidelines tackle emotional side of cancer

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Leading cancer organizations are focusing new attention on a problem that is often overlooked when treating cancer: the anxiety and depression that can affect patients and, research suggests, interfere with treatment.

A group of 19 major cancer centers, along with the American Cancer Society, on Tuesday released a set of guidelines for evaluating a patient’s level of distress. The guidelines involve a simple screening test, in which patients go through a checklist of possible causes, from insurance issues to family problems, and rank themselves on a 10-point scale.

Above a certain level, they are encouraged to seek help.

While virtually all cancer patients experience some level of distress, the anxiety, depression and fear can reach a point where it affects a person’s daily life and their ability to get needed treatment. Patients may find it difficult to even get out of bed, much less attend appointments and chemotherapy sessions. Some distraught patients avoid acknowledging their disease and cancel appointments. And distress can cause sleeplessness and confusion that may result in failure to take their medication properly, potentially lowering their chances of a cure.

Distress is an umbrella term doctors use to describe a range of responses, from fear to depression to spiritual crisis. Because many of the symptoms of distress—lack of appetite, nausea, weakness—mimic symptoms of cancer treatment, oncologists say it is important to understand the cause of the symptoms in order to know whether a change of regimen is called for, or if the patient really needs a mental-health professional or social worker. But at busy oncology offices, many doctors don’t have the time to figure out if a patient is sleeping, eating or going about regular activities. And patients are often too embarrassed to ask for help or don’t know how to recognize the signs. So these guidelines focus on helping the patients themselves identify when there is a problem that may keep them from following their treatment.

The push by cancer groups to address distress comes at a time when new therapies are enabling more patients to live longer with the disease. As cancer is increasingly considered a chronic disease—with need for ongoing, sometimes lifetime monitoring and treatment—there is growing recognition that more patients will be coping with chronic stress. And because many of the newer treatments involve oral medications taken at home, rather than intravenous therapies in a medical setting, there is increasing concern that distress could cause patients to slip from their regimens without supervision.

“Screening for distress” should be a standard part of any visit to the oncologist’s office, akin to the way questions are already routinely asked about physical symptoms, says Michael H. Levy, a member of the panel that developed the guidelines. 

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