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.
. 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