National Comprehensive Cancer Network, 2007

The National Comprehensive Cancer Network is an alliance of 21 of the world’s leading cancer centers, working together to develop treatment guidelines for most cancers and dedicated to research that improves the quality, effectiveness, and efficiency of cancer care.

The NCCN Clinical Practice Guidelines in Oncology: Distress Management (Anxiety) are updated continually and are based upon evaluation of scientific data integrated with judgment by multidisciplinary experts. The NCCN guidelines development process relies heavily on structured feedback. One group of experts, develop the guidelines and another group of experts review them, which leads to revisions and modifications, reinitiating the feedback process.

NCCN Categories of Consensus: Category 1: There is uniform NCCN consensus, based on high-level evidence, that the recommendation is appropriate. Category 2A: There is uniform NCCN consensus, based on lower level evidence including clinical experience, that the recommendation is appropriate. Category 2B: There is no uniform NCCN consensus (but no major disagreement), based on lower-level evidence, including clinical experience, that the recommendation is appropriate. Category 3: There is a major NCCN disagreement that the recommendation is appropriate. All recommendations are category 2A unless otherwise indicated.

Screening of every patient with cancer for evidence of distress. Any patient with a score of > 4 of 10 for distress should be referred to a psychosocial service. Anxiety disorder is common in most patients with cancer. Evaluate patient’s safety. Evaluate patient’s decision-making capacity. Evaluate patient to determine anxiety related to: general medical condition; withdrawal from alcohol or narcotics, pain; generalized anxiety disorder; panic disorder; post-traumatic stress disorder; phobic disorder; or obsessive-compulsive disorder. The treatment recommended for anxiety (after eliminating medical causes) is psychotherapy with (or without) an anxiolytic with or without an antidepressant. If no response, re-evaluate medication (consider neuroleptics), psychotherapy, support, and education. If no response, evaluate for depression and other psychiatric comorbidity.