背景:ASCO和综合肿瘤学会合作制定了在焦虑管理中应用综合方法的指南,抑郁症,癌症患者的疲劳和大麻素和大麻的使用。这些指南提供了基于证据的建议,以通过综合方式增强常规癌症治疗来改善预后和生活质量。
方法:由患者倡导者组成的专家小组审查了所有告知指南建议的研究,ASCO方法学家,肿瘤学提供者,和综合医学专家。小组成员审查了每个审判的证据质量,确定了等级质量评估标签,并得出了建议的结论。
结果:针对治疗期间癌症疲劳的管理提出了强有力的建议,包括面对面或基于网络的正念减压,基于正念的认知疗法,太极拳或气功。针对癌症治疗后癌症疲劳的管理提出了基于正念的计划。除非在临床试验的背景下,临床医生应建议不要使用大麻或大麻素作为癌症导向治疗。推荐的焦虑管理方式包括基于正念的干预(MBIs),瑜伽,催眠,放松疗法,音乐疗法,反射疗法,针灸,太极,和薰衣草精油。指南中最强烈的建议是应该向癌症患者提供MBI,在积极治疗和后处理期间,来解决抑郁症。
结论:癌症治疗综合干预措施的证据越来越多,现在的研究支持在癌症护理连续体中进行综合干预的益处。
BACKGROUND: ASCO and the Society for Integrative Oncology have collaborated to develop
guidelines for the application of integrative approaches in the management of anxiety, depression, fatigue and use of cannabinoids and cannabis in patients with cancer. These
guidelines provide evidence-based recommendations to improve outcomes and quality of life by enhancing conventional cancer treatment with integrative modalities.
METHODS: All studies that informed the
guideline recommendations were reviewed by an Expert Panel which was made up of a patient advocate, an ASCO methodologist, oncology providers, and integrative medicine experts. Panel members reviewed each trial for quality of evidence, determined a grade quality assessment label, and concluded strength of recommendations.
RESULTS: Strong recommendations for management of cancer fatigue during treatment were given to both in-person or web-based mindfulness-based stress reduction, mindfulness-based cognitive therapy, and tai chi or qigong. Strong recommendations for management of cancer fatigue after cancer treatment were given to mindfulness-based programs. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. The recommended modalities for managing anxiety included Mindfulness-Based Interventions (MBIs), yoga, hypnosis, relaxation therapies, music therapy, reflexology, acupuncture, tai chi, and lavender essential oils. The strongest recommendation in the
guideline is that MBIs should be offered to people with cancer, both during active treatment and post-treatment, to address depression.
CONCLUSIONS: The evidence for integrative interventions in cancer care is growing, with research now supporting benefits of integrative interventions across the cancer care continuum.