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NCCN Guidelines for Patients



Distress, Version 1.2017


What help is there?

Mental health services

include severe fear or worry, panic attacks, and

strong behavioral impulses. Anxiolytics are also

helpful for anxiety related to stress or trauma.

Mood stabilizers

. These medicines treat bipolar-

related disorders. The key feature of bipolar

disorders is an episode of elevated mood called

mania. There is strong proof that mood stabilizers

work well to treat mania.


. These medicines help with

alertness, attention, and energy. They treat attention

deficit hyperactivity disorder and improve fatigue.

Fatigue is an extreme tiredness despite getting

enough sleep. A drug named methylphenidate seems

to help cancer-related fatigue but more research is



. These medicines treat psychotic

disorders. Features of psychotic disorders include

perceiving unreal sensations (hallucinations), fixed

false beliefs (delusions), and disorganized thinking

(thought disorders). The stress of having cancer can

trigger or worsen psychotic features. Some types

of cancer or treatment can also cause or worsen


Antipsychotics treat other health conditions, too.

Your health provider may advise an antipsychotic

for anxiety if other medicines did not work.

Antipsychotics also treat delirium. Delirium is a short-

term disturbance in mental abilities. It occurs in about

43 out of every 100 persons with advanced cancer.

Some types of medicines that help people with

cancer cause the delirium.


Psychotherapy is a treatment for distress. It is also

known as “talk therapy.” Despite this name, only a

professional trained in specific methods can provide

psychotherapy. Psychotherapy is provided one-

on-one between patient and provider or in a group

setting with other patients.

There are different types of psychotherapy. CBT







herapy) focuses on changing

thoughts and actions that contribute to poor mental

health. It can help with depression, anxiety, pain, and

fatigue among people with cancer.

Supportive psychotherapy uses a flexible approach

to meet people’s changing needs. It is widely

used to help people with cancer. Subtypes of this

psychotherapy include supportive-expressive,

cognitive-existential, and meaning-centered


Cancer affects the whole family. Any family member

can experience distress. Individual counseling may

help. However, family and couples therapy may

reduce distress better than treatment for one person.

Some research has been done but more is needed to

learn how well family and couples therapy works for

families affected by cancer.

Substance use disorder treatment

The word “substance” refers to alcohol, drugs, or

tobacco. Disorders of these substances are defined

by repeated use that causes major life problems.

I was overwhelmed with anxiety about

my future. Imagine if you have to

work to maintain yourself, plus you

have extreme fatigue and then the

side effects of the medication, it’s very

difficult to cope.


Survivor, Non-Small Cell Lung Cancer