What are the NCCN palliative cancer care guidelines for distress management?

Updated: Jun 01, 2019
  • Author: Winston W Tan, MD, FACP; more...
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The NCCN guidelines for distress management include recommendations for ongoing screening, monitoring, documentation, and treatment of distress throughout all stages of cancer treatment. [13] Screening for distress using the Distress Thermometer and Problem Checklist should be conducted at the initial visit and at other appropriate intervals, especially with changes in disease status (ie, remission, recurrence, or disease progression).

Treatment is determined on the basis of the level and source(s) of distress identified. Clear roles are delineated for members of the primary oncology team as well as for psychosocial oncology professionals who deliver mental health services, social work and counseling services, and chaplaincy services. [8]

In 2014, ASCO released evidence-based guidelines for managing depression and anxiety in patients with cancer. [14]  These guidelines were adapted from the 2010 Pan-Canadian Practice Guideline: Screening, Assessment and Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer, which was developed as a synthesis of five practice guidelines, including the NCCN guidelines for stress management. [15]

The ASCO guidelines identify separate processes for screening, assessment, and treatment of depression and anxiety in adults with cancer. Timing of evaluation, types of assessment tools, and specific treatment pathways are recommended depending on the levels of symptoms reported. Recommendations for follow-up and ongoing re-assessment are also provided. [14]

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