# Psycho-oncology and distress screening

Source: https://onco.cc/technologies/psycho-oncology/  
OnCo record `psycho-oncology` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Psycho-oncology recognises and treats the anxiety, depression, fear of recurrence and existential distress that affect a third of people with cancer, using screening, psychotherapy adapted to cancer, and medication.

## Summary

About 30-40% of patients meet criteria for a mental disorder (Mehnert 2014) and depression roughly doubles mortality risk via adherence and behaviour. The NCCN Distress Thermometer (1999) and IPOS standard make distress screening part of quality cancer care (ACoS CoC requirement). Evidence-based interventions: cognitive-behavioural therapy, Meaning-Centred Psychotherapy (Breitbart), CALM therapy (Managing Cancer and Living Meaningfully, Rodin), Dignity Therapy, mindfulness-based programmes, collaborative care for depression (SMaRT Oncology-2, Lancet 2014), and, in trials, psilocybin-assisted therapy for existential distress (Ross, Griffiths 2016; phase 2 2023). Fear of cancer recurrence has specific therapies (ConquerFear). Delivery is limited by workforce; digital CBT and stepped care extend reach.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-08
- Tags: gap-fill; supportive
- Principle: Universal screening for distress with a validated tool, triage to stepped care (information, peer support, psychotherapy, psychiatry), and integration of mental-health specialists into oncology teams.
- Since: 1977
- Strengths: Screening is cheap and mandated by accreditation; Multiple manualised, trial-proven therapies; Collaborative care improves depression outcomes more than usual care
- Limitations: Screening without a referral pathway does not help; Workforce and reimbursement gaps; Little evidence in LMICs and minority populations

## Notes

- Bowel cancer: NICE NG151 names mental and emotional changes, including anxiety, depression, chemotherapy-related cognitive impairment and changes to self-perception and social identity, among the effects teams should give information about, and defines social identity as changes to a person's concept of themselves as a result of the cancer or its long-term effects. Bowel Cancer UK says talking about how you feel helps, and that a stoma care nurse specialist, a counsellor or the GP are all reasonable first calls.
- Lung cancer carries a stigma no other common cancer carries, because of its link with smoking. People who smoked, people who gave up years ago and people who never smoked all report being asked the same question, and all of them report the same effect: it makes asking for help harder. Nothing in this record treats the diagnosis as a consequence. Cancer Research UK lists shock, numbness, fear, confusion, anger, guilt and sadness among the feelings people describe, says everyone reacts in their own way, and says specialist nurses are usually the first point of call if you are finding it difficult to cope.
- Practical routes in: Cancer Research UK's nurse freephone line and Cancer Chat forum; Roy Castle's telephone support from lung cancer nurses, face to face information days and support groups, and its podcast and patient stories; Maggie's centres, which are free, need no appointment and are open to family and friends. Macmillan notes that breathlessness and anxiety feed each other, so psychological support is part of the treatment for the symptom rather than an optional extra.
- Lymphoma: Lymphoma Action describes a holistic needs assessment as part of care from the point of diagnosis onwards, not only at the end of treatment, and publishes separate material on the emotional impact of lymphoma, on waiting for results and on the particular difficulty of being told you have cancer that is not going to be treated yet. Its helpline is free on 0808 808 5555 and takes calls from relatives as well as patients.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Psycho-oncology
- NCCN Distress Management guideline: https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1431
- SMaRT Oncology-2 (Lancet 2014): https://doi.org/10.1016/S0140-6736(14)61231-9
- IPOS: https://www.ipos-society.org/
- Cancer Research UK: coping with bowel cancer: https://www.cancerresearchuk.org/about-cancer/bowel-cancer/living-with/coping
- Bowel Cancer UK: body image and sex: https://www.bowelcanceruk.org.uk/about-bowel-cancer/living-with-and-beyond-bowel-cancer/body-image-and-sex/
- Maggie's: support and information: https://www.maggies.org/support-and-information/
- NICE NG151: colorectal cancer, recommendations: https://www.nice.org.uk/guidance/ng151/chapter/Recommendations
- Cancer Research UK: coping and support when you have lung cancer: https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/coping
- Roy Castle Lung Cancer Foundation: the support available to you: https://roycastle.org/our-support/
- Macmillan: breathlessness: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness
- Lymphoma Action: the emotional impact of living with lymphoma: https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/emotional-impact-living-lymphoma
- Lymphoma Action: waiting for test and scan results: https://lymphoma-action.org.uk/information-and-support/tests-scans-and-lymphoma-staging/waiting-test-and-scan-results

## Connected records

- cancers: [Adolescent and young adult cancers (ages 15 to 39)](https://onco.cc/cancers/aya-cancers/), [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Basal cell carcinoma](https://onco.cc/cancers/basal-cell-carcinoma/), [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Cutaneous squamous cell carcinoma](https://onco.cc/cancers/cutaneous-scc/), [Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)](https://onco.cc/cancers/cutaneous-t-cell-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)](https://onco.cc/cancers/malt-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Nodal marginal zone lymphoma](https://onco.cc/cancers/nodal-marginal-zone-lymphoma/), [Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)](https://onco.cc/cancers/angioimmunoblastic-t-cell-lymphoma/), [Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)](https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Primary CNS lymphoma](https://onco.cc/cancers/primary-cns-lymphoma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Sezary syndrome](https://onco.cc/cancers/sezary-syndrome/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/), [Splenic marginal zone lymphoma](https://onco.cc/cancers/splenic-marginal-zone-lymphoma/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [A changed face and voice: body image after head and neck cancer treatment](https://onco.cc/technologies/rejuv-mind-visible-difference-head-and-neck/), [After treatment in Germany: a rehabilitation entitlement, not a leaflet](https://onco.cc/technologies/rejuv-access-survivorship-care-germany/), [After treatment in the United States: the survivorship care plan, and what the trial found](https://onco.cc/technologies/rejuv-access-survivorship-care-us/), [Alternative medicine used instead of standard treatment](https://onco.cc/technologies/alternative-medicine-instead-of-treatment/), [Anxiety after cancer, in survivors and in their partners](https://onco.cc/technologies/rejuv-mind-anxiety-after-cancer/), [Anxiety around scans, and what the evidence says about how often to scan](https://onco.cc/technologies/rejuv-mind-scan-anxiety/), [Body image after cancer treatment: how it is measured, what drives it, and what helps](https://onco.cc/technologies/rejuv-mind-body-image-after-cancer/), [Cancer rehabilitation: the discipline that puts function back](https://onco.cc/technologies/rejuv-rehab-cancer-rehabilitation/), [Children of a parent treated for cancer](https://onco.cc/technologies/rejuv-life-children-of-a-parent-with-cancer/), [Clinical hypnosis for procedures, pain and hot flushes](https://onco.cc/technologies/hypnosis-cancer-care/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [Cognitive behavioural therapy for insomnia (CBT-I)](https://onco.cc/technologies/cbt-insomnia-cancer/), [Depression during and after cancer: the interview-based prevalence, and the care model that works](https://onco.cc/technologies/rejuv-mind-depression-after-cancer/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Electronic patient-reported outcome (ePRO) symptom monitoring](https://onco.cc/technologies/epro-symptom-monitoring/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Fear that the cancer will come back: how common it is, and when it stops being ordinary worry](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence/), [Getting psychological help after cancer: the stepped-care model, and what is actually commissioned](https://onco.cc/technologies/rejuv-mind-access-to-psychological-care/), [Living with a stoma, and living after an amputation](https://onco.cc/technologies/rejuv-mind-body-after-stoma-and-limb-loss/), [Measuring fear of recurrence: the FCRI and its cut-off](https://onco.cc/technologies/rejuv-measure-fear-of-recurrence-inventory/), [Mindfulness-based stress reduction and cognitive therapy](https://onco.cc/technologies/mindfulness-based-interventions/), [Music therapy and music medicine](https://onco.cc/technologies/music-therapy-cancer/), [Partners and relationships after cancer: what the divorce data actually show](https://onco.cc/technologies/rejuv-life-partners-and-intimacy/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/), [Post-traumatic growth: what people report, and what the measurement actually captures](https://onco.cc/technologies/rejuv-mind-post-traumatic-growth/), [Post-traumatic stress after cancer: what is measured, and how much of it is measurement](https://onco.cc/technologies/rejuv-mind-traumatic-stress-after-cancer/), [Relaxation training and guided imagery](https://onco.cc/technologies/relaxation-guided-imagery/), [Screening for distress: what the thermometer can and cannot do](https://onco.cc/technologies/rejuv-mind-distress-screening/), [St John's wort: an interaction to avoid](https://onco.cc/technologies/st-johns-wort-interaction/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [The carer's own recovery: what is known about the person who is not the patient](https://onco.cc/technologies/rejuv-life-carers/), [The word survivor, and why the vocabulary is not a detail](https://onco.cc/technologies/rejuv-mind-the-word-survivor/), [Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence-treatment/), [What a prehabilitation programme actually contains, and how long it needs](https://onco.cc/technologies/rejuv-rehab-prehabilitation-programme/), [Wigs, cranial prostheses and head coverings](https://onco.cc/technologies/wigs-cranial-prosthesis/), [Yoga during and after cancer treatment](https://onco.cc/technologies/yoga-cancer/)
- people: [Elisabeth Kübler-Ross](https://onco.cc/people/elisabeth-kubler-ross/), [Gilda Radner](https://onco.cc/people/gilda-radner/), [Jimmie Holland](https://onco.cc/people/jimmie-holland/)
- key papers: [Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial](https://onco.cc/key-papers/paper-sharpe-lancet/)
- journals: [Journal of psychosocial oncology](https://onco.cc/journals/journal-of-psychosocial-oncology/), [Psycho-oncology](https://onco.cc/journals/psycho-oncology-journal/)
- terms: [Body image after breast surgery and reconstruction](https://onco.cc/terms/body-image-after-breast-surgery/), [Living with an indolent lymphoma rather than being cured of one](https://onco.cc/terms/lymphoma-living-indolent-lymphoma/), [Sexual function, fertility and body image after bowel cancer](https://onco.cc/terms/sex-fertility-after-bowel-cancer/), [The scar on the face after skin cancer surgery](https://onco.cc/terms/facial-scar-after-skin-cancer/), [The surveillance schedule, and the evidence that routine scans do not find relapse first](https://onco.cc/terms/lymphoma-living-scanxiety-and-surveillance/), [Watch and wait in follicular lymphoma: being told you have cancer and that nobody will treat it](https://onco.cc/terms/lymphoma-decision-watch-and-wait/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)
- collections: [Cancer Support Community](https://onco.cc/collections/cancer-support-community/), [CancerCare](https://onco.cc/collections/cancercare/), [Imerman Angels](https://onco.cc/collections/imerman-angels/), [Maggie's](https://onco.cc/collections/maggies-centres/), [Penny Brohn UK](https://onco.cc/collections/penny-brohn-uk/)

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