Purpose The diagnosis and treatment of cancer can have significant mental health ramifications. The National Comprehensive Cancer Network currently recommends using a distress screening tool to screen patients for distress and facilitate referrals to social service resources. Its association with radiation oncology–specific clinical outcomes has remained relatively unexplored. Methods and materials With institutional review board approval, National Comprehensive Cancer Network distress scores were collected for patients presenting to our institution for external beam radiation therapy during a 1-year period from 2015 to 2016. The association between distress scores (and associated problem list items and process-related outcomes) and radiation oncology–related outcomes, including inpatient admissions during treatment, missed treatment appointments, duration of time between consultation and treatment, and weight loss during treatment, was considered. Results A total of 61 patients who received either definitive (49 patients) or palliative (12 patients) treatment at our institution and completed a screening questionnaire were included in this analysis. There was a significant association between an elevated distress score (7+) and having an admission during treatment (36% vs 11%; P = .04). Among the patients treated with definitive intent, missing at least 1 appointment (71% vs 26%; P = .03) and having an admission during treatment (57% vs 10%; P = .009) were significantly associated with our institutional definition of elevated distress. We found no correlation between distress score and weight loss during treatment or a prolonged time between initial consult and treatment start. Conclusions High rates of distress are common for patients preparing to receive radiation therapy. These levels may affect treatment compliance and increase rates of hospital admissions. There remains equipoise in the best method to address distress in the oncology patient population. These results may raise awareness of the consequences of distress among radiation oncology patients. Specific interventions to improve distress need further study, but we suggest a more proactive approach by radiation oncologists in addressing distress.
Purpose/Objective(s): Cancer patients are known to experience high levels of various forms of psychosocial distress, which can be heightened during periods of transition or uncertainty. Initiation of radiation therapy can be a distressing experience for many patients. The NCCN currently recommends screening all cancer patients for distress using a thermometer (scoring 0-10) and questionnaire to identify patients who may benefit from referral to social work or mental health resources. This study aims to determine clinical and nonclinical factors that are associated with higher levels of patient distress and demographic differences in distress reporting to help inform better identification and treatment of distress in the radiation oncology patient population. Materials/Methods: An IRB approved retrospective analysis was conducted following a one year period of accrual of completed distress screening forms from 129 patients upon their initial consultation by one institution's Department of Radiation Oncology. Clinical data, including cancer site/stage, and demographic data, including race, age, and gender, were linked with the distress data. Both univariate and multivariate analyses were conducted to clarify the relationships between these clinical and non-clinical factors on measures of patient distress. Results: Cancer stage was positively associated with distress scores. On average, each increase in stage added 0.80 points to one's distress score (p<0.05). Patients with skin cancer had higher levels of distress than those with cancers of other sites (p<0.05). Among specific questionnaire items, feelings of sadness, fear/worry, or depression and concerns about pain were the most predictive of higher distress scores. Among these, feeling fear/worry had an 82% sensitivity (95% CI 59-94) and 71% specificity (95% CI 59-81) for a distress score of 7 or greater. Gender, age, and race were not associated with distress scores. Compared to Caucasians, African Americans had a higher prevalence of concerns about finances/insurance, transportation, work/school, and spirituality/religion, independent of distress score. Notably, 54% African Americans reported having concerns about finances/insurance, compared to 16% of Caucasians (p<0.0001). Conclusion: Patient reported distress scores are associated with cancer site and stage and specific emotional and physical factors, and race is associated with key differences in reported components of distress. Increased awareness of how the specific factors identified are associated with distress levels can allow social support services to be better tailored to the individual needs of the radiation oncology patient. Further, this analysis can help develop criteria other than a numerical distress score cutoff to be used as a trigger for referrals to social support services.
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