Clinical Guidelines

Created by NCCN and ASCO

Cancer treatment can be stressful and cause emotional distress such ase anxiety and depression. To help with this, two important organizations, NCCN and ASCO, have created guidelines for doctors to follow.

NCCN Guidelines for Patients

APOS is pleased to endorse the NCCN Guidelines for Patients Distress During Cancer Care

NCCN Guidelines: Distress Management

Clinical practice guidelines for distress screening and management in oncology were first issued in 1999 by the National ComprehensiveĀ  Cancer Network (NCCN). The primary goal of these guidelines, as described by the NCCN, was to ensure that no cancer patient with distress goes unrecognized and untreated.

The guidelines identify the need for ongoing screening, monitoring, documentation, and treatment of distress throughout all stages of cancer treatment. The guidelines offer specific recommendations about conducting screening for distress at the initial visit and at other appropriate intervals as clinically indicated, especially with changes in disease status (i.e., remission, recurrence, or disease progression). Different evaluation and treatment pathways are delineated based on the level and source(s) of distress identified using the Distress Thermometer and Problem Checklist. 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.

ASCO Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update

In 2014, the American Society of Clinical Oncology (ASCO) released a new evidence-based clinical practice guideline on managing depression and anxiety in adult patients with cancer. This guideline was adapted from the Pan-Canadian Practice Guideline: Screening, Assessment and Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer.

This ASCO guideline identifies separate processes for screening, assessment and treatment for depression in adults with cancer and for 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. Particular attention is given to the need for follow-up and ongoing re-assessment.


In 2013, NCCN developed guidelines to provide a framework for general survivorship care and management of potential long-term and/or late effects of cancer and its treatment. These guidelines focus on recommendations related to screening, evaluation, and treatment for common consequences of cancer and its treatment. These guidelines are intended to be used along with disease-specific guidelines.

The NCCN Guidelines for Survivorship cover 8 distinct areas: anxiety and depression, cognitive function, fatigue, pain, sexual function, sleep, physical activity, as well as immunizations and infections.