NCCN Guidelines® Insights: Distress Management, Version 2.2023.

These NCCN Guidelines for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. All patients experience some level of distress associated with a cancer diagnosis and the effects of the disease and its treatment regardless of the stage of disease. Clinically significant levels of distress occur in a subset of patients, and identification and treatment of distress are of utmost importance. The NCCN Distress Management Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights describe updates to the NCCN Distress Thermometer (DT) and Problem List, and to the treatment algorithms for patients with trauma- and stressor-related disorders.

Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders.

PURPOSE OF REVIEW: Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). RECENT FINDINGS: Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.

Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention.

PURPOSE: Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians. RECENT FINDINGS: We performed a review utilizing several databases, by including the most relevant studies in full journal articles investigating the problem. Workplace violence against doctors is a widespread phenomenon, present all over the world and related to a number of variables, including individual, socio-cultural, and contextual variables. During the COVID-19 pandemic, incidence of violence has increased. Data also show the possible consequences in physicians' deterioration of quality of life, burnout, and traumatic stress which are linked to physical and mental health problems, which, in a domino effect, fall on patients' quality of care. Violence against doctors is an urgent global problem with consequences on an individual and societal level. This review highlights the need to undertake initiatives aimed at enhancing understanding, prevention, and management of workplace violence in healthcare settings.

Disparities and inequalities in cancer care and outcomes in patients with severe mental illness: Call to action.

OBJECTIVES: People with severe mental illness (SMI) are at extreme risk of being stigmatized and to receive poor quality physical care. It has been demonstrated that they have higher morbidity and poorer prognosis of several medical diseases than the general population, with an at least 10-20-year reduction in life expectancy. METHODS: A special issue of Psycho-Oncology focusing on cancer care among patients affected by SMI was called by the Editorial Board of the journal, with the aim to explore cancer health disparities and inequalities among people with SMI, mortality from cancer, problems of communication between multidisciplinary oncology and psychiatric teams and need for more structured intervention (i.e., screening, prevention, treatment). RESULTS: Authors from eight countries contributed. The problem of stigma and barriers to cancer care provision for patients with SMI were studied (e.g., the complex nature of SMI and healthcare providers' misunderstanding of SMI). Key barriers were related to both patients, clinicians and institutional problems, such as fragmentation of care. A higher mortality from cancer and poor knowledge about cancer risk-factors was shown in patients with SMI. Models of intervention were also proposed. CONCLUSIONS: Several conclusions have been recommended by the authors, such as the need for guidelines and clinical procedures specific for cancer care in mental health settings; large-scale studies to address the disparities of care in people with SMI; a larger vision of psychosocial oncology as the facilitator of the liaison between oncology and psychiatry.

Update on the Implementation of NCCN Guidelines for Distress Management by NCCN Member Institutions.

The first NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Distress Management were published in 1999. Since then, a number of other organizations have advocated for distress screening. Previous surveys of distress screening showed modest progress in implementation of the NCCN Guidelines for Distress Management by NCCN Member Institutions (MIs); this review examined whether further progress has been made. Representatives appointed to the NCCN Distress Management Panel or their designee were asked to complete an online survey in the summer of 2018. The survey was developed based on similar surveys performed in 2005 and 2012 and a survey of psychosocial staffing conducted in NCCN MIs in 2012. New items solicited details about triaging, rescreening, formal screening protocols, and tracking of distressed patients. The survey was completed by representatives from 23 of 27 NCCN MIs (85%). Among the responding institutions, 20 (87%) currently conduct routine screening for distress and 3 are piloting routine screening. All respondents reported use of a self-report measure to screen for distress, with the Distress Thermometer most often used. A total of 70% of respondents rescreen patients for distress and 83% reported having a formal distress screening protocol in place. Once triaged, 65% of institutions who routinely screen for distress track clinical contacts and referrals; 70% track rates of adherence to screening protocols. Findings suggest wide acceptance and implementation of the NCCN Guidelines. Most respondents reported the existence of a formal distress screening protocol, with routine tracking of clinical contacts and referrals and rates of protocol adherence. Clinical experience and the American College of Surgeons Commission on Cancer accreditation standard for cancer centers appear to have resulted in greater adoption and implementation of the guidelines, but considerable opportunities for improvement remain.

Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology.

Distress is defined in the NCCN Guidelines for Distress Management as a multifactorial, unpleasant experience of a psychologic (ie, cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Early evaluation and screening for distress leads to early and timely management of psychologic distress, which in turn improves medical management. The panel for the Distress Management Guidelines recently added a new principles section including guidance on implementation of standards of psychosocial care for patients with cancer.

Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review.

Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as demoralization, are among the most common psychiatric consequences of cancer patients, affecting up to 60% of patients. In spite of the negative effects and the burden for cancer patients and their families, these disorders often remain under-recognized and undertreated. The present review aims at summarizing the relevant data concerning the diagnostic challenges within the depressive spectrum disorders among cancer patients. Also, the most relevant data relative to integrated intervention, including psychopharmacological and psychosocial treatment, for depression in cancer patients are critically evaluated. It is mandatory that health care professionals working in oncology (e.g., oncologists, surgeons, radiation oncologists, primary care physicians, nurses, social workers, psychologists) receive training in the diagnosis and integrated management of the different types of disorder within the spectrum of clinical depression.

Psychosocial Issues in Patients with Head and Neck Cancer: an Updated Review with a Focus on Clinical Interventions.

PURPOSE OF REVIEW: There are frequent and diverse psychosocial issues that afflict patients with head and neck cancer (HNC) across the illness trajectory, prompting a focus on clinical interventions to prevent and mitigate psychosocial distress. We sought to characterize current understanding on the cause, effects, and interplay of various psychosocial factors in HNC and summarize updated, evidence-based interventions. RECENT FINDINGS: The psychosocial experience of patients with HNC is characterized by a disproportionately high incidence of depression, suicide, continued substance dependence/abuse, and distress related to relationship conflict, social isolation, disfigurement, and damage to self-image. As we move towards a more thorough understanding and greater appreciation of the relationship between HNC and patient quality of life (QoL), future research focuses on implementation of effective, accessible clinical interventions to alleviate psychosocial distress in this population.

The burden of psychosocial morbidity related to cancer: patient and family issues.

With cancer incidence increasing over time, attention to the burden of related psychiatric and psychosocial consequences of the disease and treatment is a major topic for both cancer patients and their caregivers. Among cancer patients, psychiatric (e.g. adjustment, anxiety, depressive disorders) and neuropsychiatric disorders (e.g. cognitive disorders secondary to treatment, delirium) have been shown to affect an average of 30-35% patients, with differences according to stage and type of cancer. Also other psychosocial syndromes (e.g. demoralization, health anxiety, irritable mood) not taken into account in usual nosological systems should be considered for their impact on the patient's quality-of-life. Also, it has been repeatedly reported that psychological distress reverberates substantially throughout the nuclear family, and that a family approach is necessary in cancer care, with the caregiver-patient dyad as a unit to be the focus and direction of assessment and intervention. In this review the most significant psychosocial disorders causing burden for cancer patients and their caregivers are examined, and the main methods of assessment for more proper referral and treatment are summarized.

A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness.

The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

Cancer-Related Fatigue, Version 2.2015.

Cancer-related fatigue is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. It is one of the most common side effects in patients with cancer. Fatigue has been shown to be a consequence of active treatment, but it may also persist into posttreatment periods. Furthermore, difficulties in end-of-life care can be compounded by fatigue. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Related Fatigue provide guidance on screening for fatigue and recommendations for interventions based on the stage of treatment. Interventions may include education and counseling, general strategies for the management of fatigue, and specific nonpharmacologic and pharmacologic interventions. Fatigue is a frequently underreported complication in patients with cancer and, when reported, is responsible for reduced quality of life. Therefore, routine screening to identify fatigue is an important component in improving the quality of life for patients living with cancer.

Managing anxiety and depression during treatment.

Here, we review the prevalence and treatment of anxiety and depression among patients with breast cancer. Cancer-related symptoms include similarities to responses to traumatic stress. Well-developed screening devices for identifying and tracking psychiatric comorbidity are discussed. Basic principles of psychopharmacology, and individual and group psychotherapy are presented. Finally, effects of effective treatment of anxiety and depression on quality of life and overall survival are reviewed.

Population-based initiatives in college mental health: students helping students to overcome obstacles.

College students' need for mental health care has increased dramatically, leaving campus counseling and mental health centers struggling to meet the demand. This has led to the investigation and development of extra-center, population-based interventions. Student-to-student support programs are but one example. Students themselves are a plentiful, often-untapped resource that extends the reach of mental health services on campus. Student-to-student programs capitalize on students' natural inclination to assist their peers. A brief review of the prevalence and effects of mental disorders in the college population is provided, followed by a broad overview of the range of peer-to-peer programs that can be available on college campuses. Two innovative programs are highlighted: (1) a hospital- and community-based program, the College Mental Health Program (CMHP) at McLean Hospital, and 2) the Student Support Network (SSN) at Worcester Polytechnic Institute. The subsequent section reviews the literature on peer-to-peer programs for students with serious and persistent mental illness for which there is a small but generally positive body of research. This lack of an empirical basis in college mental health leads the authors to argue for development of broad practice-research networks.

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.

Current psychiatric treatment for college students with depression only, anxiety only, or comorbid depression & anxiety (2013-2019).

BACKGROUND: This epidemiological study described changes in the estimated prevalence of current pharmacological and/or psychotherapy-based treatment utilization among college students with depression only, anxiety only, or comorbid depression & anxiety. METHODS: A sample of 190,500 weighted responses was collected through the 2013-2019 Healthy Minds Study questionnaires. Annual prevalence estimates of depression only, anxiety only, or comorbid depression & anxiety were computed. Current use of therapy, pharmacological services, or dual treatment among students with depression and/or anxiety were examined via descriptive statistics. RESULTS: Estimated prevalence of college students who screened positive for depression only, anxiety only, and comorbid depression & anxiety escalated from 2013 to 2018-2019. When assessed individually, rates of currently using any psychiatric medication, participating in therapy, and engaging in concurrent medication & therapy services significantly rose among students with depression and/or anxiety. However, temporal trends in the current use of specific classes of psychiatric medications among young adults with depression only, anxiety only, or comorbid depression & anxiety differed by medication class. LIMITATIONS: This study was unable to assess psychiatric prescribing practices, depression or anxiety diagnoses, and prior mental health treatment. CONCLUSIONS: An increasing proportion of college students are reporting depression and/or anxiety symptoms as well as pharmacological and/or psychotherapy service utilization when comparing rates from 2013 to 2018-19. Although this may indicate increasing acceptability to disclose and seek treatment for problematic symptomology, continued surveillance of college populations is needed to identify students at risk for adverse psychiatric health outcomes, especially during the coronavirus disease 2019 pandemic.

Suicide prevention and COVID-19.

INTRODUCTION: Suicide prevention during Covid 19 has become a global priority because the current pandemic has led to societal difficulties threatening the fabric of our lifestyle with increased morbidity and mortality. Modelling studies published since the COVID 19 pandemic was declared in March 2020 estimate that suicide rates will increase by anywhere between 1% to 145% globally in response to the pandemic and action needs to be taken. METHODS: A narrative literature review on high quality evidence sources limited to human studies and publications written in English language only has been used to examine the relationship of COVID 19 and existing mental illness or history of mental illness, suicide prevention strategies and changes in overall suicide rates. RESULTS: A total of 39 papers are summarised and grouped using the headings aetiological factors, proposed interventions to increase access and national policies to provide a framework for suicide prevention during pandemics such as COVID 19. This review indicates that 1) investing in active labour market programmes will result in a decreased suicide rate during times of high unemployment 2) People in low paid and casual jobs require specific support because they are most financially vulnerable during a pandemic related crisis 3) Women require specific support during a pandemic because of the type of employment they have and because they often carry a greater proportion of the domestic burden and are at increased risk of domestic violence during lockdown and crisis 4) Mental health and substance misuse services need to be appropriately funded and prioritised during and post pandemic, due to the associated increase in substance misuse during a pandemic causing worsening mental health and increased risk of suicide 5) National Suicide Prevention Strategies should be developed by all countries and should anticipate response to a range of disasters, including a pandemic 6) Suicide prevention is everybody's business and National Suicide Prevention Strategies should adopt a whole-systems approach including mental health services, primary care, social care, NGO's and other community stakeholders 7) Suicide is preventable 8) It is essential to prioritise suicide prevention strategies in the COVID and post-COVID period to ensure that lives are saved. DISCUSSION: Increase in suicide is not inevitable and suicide prevention during pandemics and post COVID 19 pandemics requires a collaborative whole system approach. We require real time data to inform dynamic action planning.

Use of psychiatric medication by college students: A decade of data.

OBJECTIVES: Given the rising prevalence of psychiatric symptomatology among college students, this analysis aims to identify temporal trends in psychiatric medication usage. METHODS: This analysis used data from the Healthy Minds Study Survey administered between 2007 and 2019, yielding a sample of 320,817 university students. Survey data were examined via descriptive analyses. RESULTS: Over the last decade from 2007 to 2018-2019, there was an increase in use of nearly all classes of psychiatric medications, with reported antidepressant medication (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], etc.) use increasing from 8.0% to 15.3%, anti-anxiety medication (benzodiazepines, buspirone, etc.) from 3.0% to 7.6%, psychostimulants from 2.1% to 6.3%, antipsychotics from 0.38% to 0.92%, and mood stabilizers from 0.8% to 2.0% (all p < 0.0001), respectively. In addition, the use of more than one category of medication at a time has increased, from 28.2% in 2007 to 40.8% in 2018-2019 (p < 0.0001). The proportion of students who received their most recent prescription for psychiatric medication from primary care providers has risen from 49.1% in 2007 to 58.8% in 2018-2019 (p < 0.0001), while the proportion receiving these prescriptions from psychiatric providers did not increase significantly and stands at 36.1% in 2018-2019. The percentage of students taking psychiatric medication without a prescription varied from year to year, starting at 11.9% in 2007 and ending at 7.7% in 2018-2019 (p < 0.0001). The proportion of students who discussed their use of psychiatric medication with their doctor or other health professional three or more times in the previous year has increased from 39.2% in 2007 to 49.5% in 2018-2019 (p < 0.0001). CONCLUSIONS: The proportion of college students who have taken psychiatric medications of all categories has risen in the last decade; these students are increasingly likely to be on more than one kind of psychiatric medication and be treated by healthcare providers at a greater frequency. Despite the growing complexity of student treatment, the proportion of students receiving psychiatric medication management by psychiatric providers has not changed, while the proportion receiving services in primary care settings has increased.