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Canada Leads the Way

Canada-flagby Anne Katz PhD, RN

The American Society of Clinical Oncologists (ASCO) recently released new guidelines that are important for survivorship care. One is on screening, assessment and care of anxiety and depressive symptoms in adults with cancer (Andersen et al., 2014; published online on April 14, 2014; DOI:10.1200/JCO.2013.52.4611). This guideline is an adaptation of the Pan-Canadian Guideline on screening (Howell et al., 2011) however ASCO has made some changes based on local context and the “practice beliefs” of the committee members in the US.

The adapted guideline recommends periodic evaluation of adults with cancer along the disease trajectory, using validated screening tools with options for treatment based on severity of symptoms and other information. It is noted that failure to identify and treat anxiety and depression impacts on quality of life and has the potential to increase disease-related morbidity and mortality.

The guideline includes the PHQ Nine-Symptom Depression Scale and the GAD-7 to assess anxiety as well as a list of other validated measures that can be used to assess depression and anxiety. Included also are two care maps for screening and assessing as well as treating anxiety and depression.

Similarly, ASCO has adapted the Pan-Canadian guideline for the screening, assessment and management of fatigue in adult survivors of cancer (Bower et al, 2014). The guideline recommends assessment of fatigue after completion of primary treatment and if moderate to severe fatigue is identified, treatment strategies should be recommended. Recommendations from the NCCN Guideline for Survivorship are also included in this adapted guideline.

It is heartening to see the endorsement of Canadian guidelines by this large and influential American Society. It is also good to see that our neighbours to the south have not attempted to reinvent the wheel and have instead chosen, after a thorough review process, to adapt the Pan-Canadian guidelines.






Andersen, B.,  DeRubeis, R.,  Berman, B., Gruman, J.,. Champion, V., Massie, M., Holland, J.,. Partridge, A., Bak, K., Somerfield, M. & Rowland, J. (2014). Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults With Cancer: An American Society of Clinical Oncology Guideline Adaptation. JCO.2013.52.4611; published online on April 14, 2014;

Bower, J., Bak, K., Berger, A.,  Breitbart, W., Escalante, C., Ganz, P., Schnipper, H.,  Lacchetti, C., Ligibel, J., Lyman, G.,  . Ogaily, M., Pirl, W. &  Paul B. Jacobsen, P. (2014). Screening, Assessment, and Management of Fatigue in Adult Survivors of Cancer: An American Society of Clinical Oncology Clinical Practice Guideline Adaptation. JCO JCO.2013.53.4495; published online on April 14, 2014

Howell D, Keller-Olaman S, Oliver TK, et al. (2013). A pan-Canadian practice guideline and algorithm:

Screening, assessment and supportive care of adults with cancer-related fatigue. Curr Oncol

20:e233-e246, 2013

Howell D, Keller-Olaman S, Oliver T, Hack T, Broadfield L, Biggs K, Chung J,

Esplen M-J, Gravelle D, Green E, Gerin-Lajoie C, Hamel M, Harth T, Johnston P,

Swinton N, Syme A. A Pan-Canadian Practice Guideline: Screening, Assessment and

Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer, Toronto:

Canadian Partnership Against Cancer (Cancer Journey Action Group) and the Canadian

Association of Psychosocial Oncology, August 2010.

Accessed at



anneDr Anne Katz is a clinical nurse specialist and AASECT-certified sexuality counsellor at CancerCare Manitoba. She has written 2 books on the topic of cancer survivorship (After You Ring the Bell: Ten Challenges for the Cancer Survivor [Hygeia Media] and Surviving after Cancer: Living the New Normal [Rowman & Littlefield]) and 3 on cancer and sexuality.

“I am thrilled to be taking on this new role as editor of the Survivorship Section for CKN.  Initially you will see regular commentary from me on key aspects of the survivorship experience that I hope will lead you to think about, talk about with your patients and care providers, and then explore further in your own reading and research. Coupled with this will be key references to new research findings in this exciting growth area of cancer care.”

Dr. Katz’ professional life is focused on providing information, education and counselling to people with cancer and their partners about sexual changes that can occur during and after treatment.  But there is another important aspect to this work; Dr. Katz wants every cancer patient to be able to have a discussion about sexuality with their health care providers. And so she travels across North America (as well as  Europe and the Caribbean!) teaching health care providers to ask their patients about this important part of quality of life.

If you’d like to know more about Dr. Katz and the work she does, or if you’d like her to come to your city or town, health care facility or doctor’s office, you can contact her by email.  

“I am always eager to spread the word and break the silence.”

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