（2025.V1）NCCN临床实践指南：心理痛苦的处理.pdf（英文版 ）

Version 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Clinical Practice Guidelines in Oncology(NCCN Guidelines)Distress ManagementVersion 1.2025 November 18,2024ContinueNCCN.orgNCCN Guidelines for Patients available at www.nccn.org/patientsNCCN recognizes the importance of clinical trials and encourages participation when applicable and available.Trials should be designed to maximize inclusiveness and broad representative enrollment.NCCN Guidelines Version 1.2025Distress ManagementVersion 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexTable of ContentsDiscussion*Michelle B.Riba,MD,MS/Chair University of Michigan Rogel Cancer Center*Jessica Vanderlan,PhD/Vice-Chair Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of MedicineBarbara Andersen,PhD The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research InstituteChloe E.Atreya,MD,PhD UCSF Helen Diller Family Comprehensive Cancer CenterIIana Braun,MD Dana-Farber/Brigham and Womens Cancer CenterWilliam S.Breitbart,MD Memorial Sloan Kettering Cancer CenterBenjamin W.Brewer,PsyD University of Colorado Cancer CenterYamna Channa,MBBS Fred&Pamela Buffett Cancer CenterCheyenne Corbett,PhD Duke Cancer InstituteJesse R.Fann,MD,MPH Fred Hutchinson Cancer CenterJill Farabelli,LCSW,APHSW-C Abramson Cancer Center at the University of PennsylvaniaStewart Fleishman,MD ConsultantSofia Garcia,PhD Robert H.Lurie Comprehensive Cancer Center of Northwestern UniversityDonna B.Greenberg,MD Mass General Cancer CenterRev.George F.Handzo,MA,MDiv ConsultantAmy Horyna,MSW,LCSW,OSW-C Huntsman Cancer Institute at the University of Utah Chao-Hui Huang,PhD,MEd,MA ONeal Comprehensive Cancer Center at UABSean Hutchinson,MD UT Southwestern Simmons Comprehensive Cancer CenterShelley Johns,PsyD Indiana University Melvin and Bren Simon Comprehensive Cancer CenterJennifer Keller,MSS,LCSW,OSW-C Fox Chase Cancer CenterShannon La Cava,PsyD UCLA Jonsson Comprehensive Cancer CenterSheila Lahijani,MD Stanford Cancer InstituteHeather Leeper,MD,MS The UChicago Medicine Comprehensive Cancer CenterSara Martin,MD Vanderbilt-Ingram Cancer CenterDebraj Mukherjee,MD,MPH Johns Hopkins Kimmel Cancer CenterShehzad K.Niazi,MD Mayo Clinic Comprehensive Cancer CenterMegan Pailler,PhD Roswell Park Comprehensive Cancer CenterFrancine Parnes,JD,MA Patient AdvocateVinay Rao,DO Yale Cancer Center/Smilow Cancer HospitalXiomara Rocha-Cadman,MD City of Hope National Medical CenterEli Scher,DO Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer InstituteJessica Schuster,MD University of Wisconsin Carbone Cancer CenterLora M.A.Thompson,PhD Moffitt Cancer CenterAngela Usher,LCSW,OSW-C,PhD UC Davis Comprehensive Cancer Center Alan D.Valentine,MD The University of Texas MD Anderson Cancer CenterNCCNSusan Darlow,PhDSarah Montgomery,BAContinueNCCN Guidelines Panel Disclosures Internal medicine Medical oncology Neurosurgery#Nursing Patient advocacy Psychiatry,psychology,including health behavior Supportive care including palliative,pain management,pastoral care,and oncology social work*Discussion Section Writing Committee NCCN Guidelines Version 1.2025Distress ManagementVersion 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexTable of ContentsDiscussionFind an NCCN Member Institution:https:/www.nccn.org/home/member-institutions.NCCN Categories of Evidence and Consensus:All recommendations are category 2A unless otherwise indicated.See NCCN Categories of Evidence and Consensus.NCCN Distress Management Panel MembersSummary of the Guidelines UpdatesKey Terms:Distress and Definition of Distress in Cancer(DIS-1)Standards of Care for Distress Management(DIS-2)Overview of Evaluation and Treatment Process(DIS-3)Management of Expected Distress Symptoms(DIS-4)NCCN Distress Thermometer and Problem List(DIS-A)Psychosocial Distress Patient Characteristics(DIS-B)Psychological/Psychiatric Treatment Guidelines(DIS-5)Social Work and Counseling Services:Practical Problems(DIS-22)Social Work and Counseling Services:Psychosocial Problems(DIS-23)Chaplaincy Care(DIS-24)Principles for Implementation of Standards and Distress Management Guidelines(DIS-25)Institutional Evaluation of Standards of Care(DIS-26)Abbreviations(ABBR-1)For Non-Pain Symptom Management and Palliative Issues,see the NCCN Guidelines for Palliative CareFor Cancer Pain,see the NCCN Guidelines for Adult Cancer PainThe NCCN Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment.Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patients care or treatment.The National Comprehensive Cancer Network(NCCN)makes no representations or warranties of any kind regarding their content,use or application and disclaims any responsibility for their application or use in any way.The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network.All rights reserved.The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN.2024.NCCN Guidelines Version 1.2025Distress ManagementVersion 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.Note:All recommendations are category 2A unless otherwise indicated.NCCN Guidelines IndexTable of ContentsDiscussionUPDATESDIS-2 Bullet added:Social determinants of health(SDoH)can affect cancer-related distress and impact health outcomes.By highlighting these practical concerns,the NCCN Distress Thermometer and Problem List can facilitate the evaluation of these factors and inform care.DIS-3 Footnote e modified:Psychiatrist,psychologist,advanced practice clinicians,or social worker.Licensed mental health providers including psychiatrists,psychologists,advanced practice clinicians,clinical social workers,mental health counselors,and marriage and family therapists.(Also for DIS-5)DIS-4 InterventionsBullet 2 modified:Clarify diagnosis,treatment options and intent,and side effectsBullet 7 modified:Support groups,shared medical visits,and/or individual counseling including evidence-based interventionsBullet 9 modified:Mind-body practices(eg,relaxation,mindfulness,meditation,yoga)and/or creative therapies(eg,art,dance,music)Re-evaluation pathway modified:Monitor functional level and reevaluate as appropriateDIS-A Problem listPractical concern added:SafetyPractical concern modified:Housing/UtilitiesDIS-9 TreatmentDanger to self or others,bullet 3,sub-bullet 3 modified:Safety planning Take precautions to prevent suicide(Also for DIS-11,DIS-16,DIS-17)DIS-10 TreatmentNo/partial response,bullet 2 modified:Consider electroconvulsive therapy or other somatic therapiesDIS-14 Treatment,bullet removed:Consider anti-psychotic medications(urgently administer)DIS-22 Type of problem,bullet added:SafetyDIS-24 Chaplaincy assessment,bullet added:Feelings of guilt/shame/blameUpdates in Version 1.2025 of the NCCN Guidelines for Distress Management from Version 2.2024 include:Global Changes The following language has been changed where applicable for consistency throughout the guidelines:Assess patient safetyDecision-making capacity and safety impaired Impaired capacity to make decisions and inadequate patient safetyAssess decision-making capacity to make decisionsAttend to Assess patient safetyConsider Assess capacity to make decisionsNCCN Guidelines Version 1.2025Distress ManagementVersion 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.Note:All recommendations are category 2A unless otherwise indicated.NCCN Guidelines IndexTable of ContentsDiscussionThe term“distress”was chosen because it:Is more acceptable and less stigmatizing than“psychiatric,”“psychosocial,”or“emotional”Sounds“normal”and less embarrassing Can be defined and measured by self-reportDIS-1“DISTRESS”Distress is a multifactorial unpleasant experience of a psychological(ie,cognitive,behavioral,emotional),social,spiritual,and/or physical nature that may interfere with ones ability to cope effectively with cancer,its physical symptoms,and its treatment.Distress extends along a continuum,ranging from common normal feelings of vulnerability,sadness,and fears to problems that can become disabling,such as depression,anxiety,panic,social isolation,and existential and spiritual crisis.DEFINITION OF DISTRESS IN CANCERNCCN Guidelines Version 1.2025Distress ManagementVersion 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.Note:All recommendations are category 2A unless otherwise indicated.NCCN Guidelines IndexTable of ContentsDiscussionDIS-2STANDARDS OF CARE FOR DISTRESS MANAGEMENT Distress should be recognized,monitored,documented,and treated promptly at all stages of disease and in all settings.Screening should identify the level and nature of the distress.Ideally,patients should be screened for distress at every medical visit as a hallmark of patient-centered care.At a minimum,patients should be screened for distress at their initial visit,at appropriate intervals,and as clinically indicated,especially with changes in disease status(ie,remission,recurrence,progression,treatment-related complications).Distress should be assessed and managed according to clinical practice guidelines.Patients,families,and treatment teams should be informed that distress management is an integral part of total medical care and is provided with appropriate information about psychosocial services in the treatment center and the community.Because experiences of prejudice and discrimination may contribute significantly to distress,particularly among individuals with mental illness and other groups that have been marginalized or made vulnerable,health care systems should ensure a culture of diversity,equity,and inclusiveness in the management of cancer-related distress.Social determinants of health(SDoH)can affect cancer-related distress and impact health outcomes.By highlighting these practical concerns,the NCCN Distress Thermometer and Problem List can facilitate the evaluation of these factors and inform care.Interdisciplinary institutional committees should be formed to implement standards for distress management.Educational and training programs should be developed to ensure that health care professionals and certified chaplains have knowledge and skills in the assessment and management of distress.Licensed mental health professionals and certified chaplains experienced in psychosocial aspects of cancer should be readily available as staff members or by referral.Medical care contracts should include adequate reimbursement for services provided by mental health professionals.Clinical health outcomes measurement should include assessment of the psychosocial domain(eg,quality of life and patient and family satisfaction).Quality of distress management programs/services should be included in institutional continuous quality improvement(CQI)projects.NCCN Guidelines Version 1.2025Distress ManagementVersion 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.Note:All recommendations are category 2A unless otherwise indicated.NCCN Guidelines IndexTable of ContentsDiscussionBrief screeningfor distress(DIS-A):a,b Screening tool Problem listDIS-3OVERVIEW OF EVALUATION AND TREATMENT PROCESSa The NCCN Problem List and the NCCN Distress Thermometer Screening Tool may be modified to fit the needs of the local population.b See Discussion(MS-8)for information about other validated screening tools.c Consider referral for palliative care management(see NCCN Guidelines for Palliative Care and NCCN Guidelines for Adult Cancer Pain).d Psychosocial Distress Patient Characteristics(DIS-B).e Licensed mental health providers including psychiatrists,psychologists,advanced practice clinicians,clinical social workers,mental health counselors,and marriage and family therapists.Refer to NCCN GuidelinesTable of Contents for Supportive Care GuidelinesClinical evidence of moderate to severe distress or score of 4 on screening tool(DIS-A)aUnrelieved physical symptoms,treat as per disease-specific or supportive care guidelinesc Clinical evidence of mild distress or score of 4 on screening tool(DIS-A)EVALUATIONTREATMENTClinical assessment(which may include clinical interviews,and validated scales/screeners for anxiety and depression)by primary oncology team of oncologist,nurse,advanced practice professional,or social worker for:Increased riskdPeriods of vulnerabilityRisk factors for distress Practical problems Family problems Spiritual/religious concerns Physical problemsc Social problems Emotional problems,including anxiety and depressionReferralIf necessaryPrimaryoncology team+resources available Mental healthprofessionaleSocial work and counselingservices Chaplaincy carePsychological/Psychiatric TreatmentGuidelines(DIS-5)Social Work and Counseling Services(DIS-22)Chaplaincy Care(DIS-24)Expected Distress Symptoms(DIS-4)Follow-up and communication with primary oncology team,primary care physician,and family/caregiversNCCN Guidelines Version 1.2025Distress ManagementVersion 1.2025,11/18/2024 2024 National Comprehensive Cancer Network(NCCN),All rights reserved.NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.Note:All recommendations are category 2A unless otherwise indicated.NCCN Guidelines IndexTable of ContentsDiscussion Fear and worry about the future Concerns about illness Sadness about loss of usual health Anger,feeling out of control Poor sleep(NCCN Guidelines for Survivorship;Sleep Disorders SSD-1)Poor appetite Poor concentration Preoccupation with thoughts of illness and death Concerns with treatment side effects Concerns about social role (eg,as parent)Spiritual/existential concerns Financi