Distress management.

The integration of psychosocial care into the routine care of all patients with cancer is increasingly being recognized as the new standard of care. These NCCN Clinical Practice Guidelines in Oncology for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. They are intended to assist oncology teams identify patients who require referral to psychosocial resources and to give oncology teams guidance on interventions for patients with mild distress to ensure that all patients with distress are recognized and treated. (JNCCN 2013;11:190–209) NCCN Categories of Evidence and Consensus Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. All recommendations are category 2A unless otherwise noted. Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please Note The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Distress Management are not printed in this issue of JNCCN but can be accessed online at NCCN.org. © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Distress Management Panel At the beginning of each NCCN Guidelines panel meeting, panel members review all potential conflicts of interest. NCCN, in keeping with its commitment to public transparency, publishes these disclosures for panel members, staff, and NCCN itself. Individual disclosures for the NCCN Distress Management Panel members can be found on page 209. (The most recent version of these guidelines and accompanying disclosures are available on the NCCN Web site at NCCN.org.) These guidelines are also available on the Internet. For the latest update, visit NCCN.org. Distress Management NCCN Guidelines® © JNCCN–Journal of the National Comprehensive Cancer Network | Volume 11 Number 2 | February 2013 191 Journal of the National Comprehensive Cancer Network Text continues on p. 199 chosocial problems in patients with cancer. They are intended to help oncology teams identify patients who require referral to psychosocial resources and to provide oncology teams guidance on interventions for patients with mild distress. These guidelines also provide guidance for social workers, certified chaplains, and mental health professionals who describe treatments and interventions for various psychosocial problems as they relate to patients with cancer. Psychosocial Problems in Patients With Cancer In the past 2 decades, dramatic advances in early detection and treatment options have increased the overall survival rates in patients of all ages with cancer. At the same time, these improved treatment options are also associated with substantial longterm side effects: fatigue, pain, anxiety, and depression are the most frequently reported cancer-related symptoms that interfere with the patient’s ability to perform daily activities.2 In addition, the physiologic effects of cancer itself and certain anticancer drugs can also be nonpsychological contributors to distress symptoms.3–6 Furthermore, patients with cancer may have preexisting psychological or psychiatric conditions that impact their ability to cope with cancer. The prevalence of psychological distress in individuals varies by the type and stage of cancer and by patient age. In a study of 4496 patients with cancer, Zabora et al7 reported that the overall prevalence of distress was 35.1%, which varied from 29.6% for NCCN Distress Management Panel Members *Jimmie C. Holland, MD/Chairθ Memorial Sloan-Kettering Cancer Center Barbara Andersen, PhDθ The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute William S. Breitbart, MDθÞ Memorial Sloan-Kettering Cancer Center Luke O. Buchmann, MD¶ Huntsman Cancer Institute at the University of Utah Bruce Compas, PhDθ Vanderbilt-Ingram Cancer Center Teresa L. Deshields, PhDθ Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine Moreen M. Dudley, MSWξ Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance Stewart Fleishman, MD£θ Beth Israel Cancer Center Caryl D. Fulcher, RN, MSN, CSθ Duke Cancer Institute Donna B. Greenberg, MDθÞ Massachusetts General Hospital Cancer Center Carl B. Greiner, MDθ UNMC Eppley Cancer Center at The Nebraska Medical Center Rev. George F. Handzo, MA, MDiv£ Consultant Laura Hoofring, MSN, APRN#θ The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Charles Hoover¥ Patient Advocate Paul B. Jacobsen, PhDθ Moffitt Cancer Center Elizabeth Kvale, MD£ University of Alabama at Birmingham Comprehensive Cancer Center Michael H. Levy, MD, PhD†£ Fox Chase Cancer Center Matthew J. Loscalzo, MSW£ City of Hope Comprehensive Cancer Center Randi McAllister-Black, PhDθ City of Hope Comprehensive Cancer Center Karen Y. Mechanic, MDθ Fox Chase Cancer Center Oxana Palesh, PhD, MPHθ Stanford Cancer Institute Janice P. Pazar, RN, PhD St. Jude Children’s Research Hospital/ The University of Tennessee Health Science Center Michelle B. Riba, MD, MSθ University of Michigan Comprehensive Cancer Center Kristin Roper, RN# Dana-Farber/Brigham and Women’s Cancer Center Alan D. Valentine, MDθ The University of Texas MD Anderson Cancer Center Lynne I. Wagner, PhDθ Robert H. Lurie Comprehensive Cancer Center of Northwestern University Michael A. Zevon, PhDθ Roswell Park Cancer Institute NCCN Staff: Deborah A. Freedman-Cass, PhD, and Nicole R. McMillian, MS KEY: *Writing Committee Member Specialties: θPsychiatry, Psychology, Including Health Behavior; ÞInternal Medicine; £Supportive Care Including Palliative, Pain Management, Pastoral Care, and Oncology Social Work; ξBone Marrow Transplantation; #Nursing; †Medical Oncology; ¶Surgery/Surgical Oncology; ¥Patient Advocacy