06/22/2017

NCCN has published updates to the NCCN Guidelines® for Distress Management

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Distress Management. These NCCN Guidelines^® are currently available as Version 1.2017. 

• Global Changes: “Substance abuse” changed to “Substance use disorder”.
  
  
• Definition of Distress in Cancer (DIS-2)
  • The definition was revised, “Distress is a multifactorial unpleasant emotional experience of a psychological (ie, cognitive, behavioral, emotional), social, spiritual, and/or spiritual physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment....”

• Management of Expected Distress Symptoms: Under “Interventions,” a new bullet was added: “Assess coping strategies and contributing factors.” (DIS-5)
  
  
• Psychosocial Distress Patient Characteristics (DIS-B)
  • Periods of increased vulnerability
    • New bullet added: “Learning about genetic/familial cancer risk.”
    • Bullet revised: “Admission to/discharge from hospital .”

• Psychological/Psychiatric Treatment Guidelines: Under “Evaluation for,” “Substance use disorder” was added. (DIS-6)
  
  
• Depressive Disorders (DIS-10)
  • First column: Last bullet revised: “Dysthymia Persistent depressive disorder.”
  • Under “Evaluation,” a new bullet was added: “Evaluate using PHQ-2 or PHQ-9.”
  • “Danger to self or others” pathway: “Assure safety of others” added as a treatment option. This change was also made in the “Bipolar and Related Disorders” algorithm (DIS-12) and the “Trauma and Stressor-Related Disorders” algorithm. (DIS-18)

• Anxiety Disorders: Under “Signs and symptoms...” (DIS-16)
  • “Agoraphobia” and “Substance/medication-induced anxiety disorder” were added.
  • Fourth bullet revised from “Phobic disorder” to “Specific phobia”.

• Trauma and Stressor-Related Disorders: Adjustment Disorders: Under “Evaluation,” “Assess for past trauma” was added. (DIS-17)
  
  
• Personality Disorders: “Dependent” added under “Signs and symptoms” and under “Evaluation, “Assess home situation” added. (DIS-23)
  
  
• Psychosocial Problems:  Under “Type of problem” the fourth bullet was revised: “Absent or unclear advance directive.” (DIS-25)