Pilot study of single‐day distress screening with the NCCN distress thermometer to evaluate the feasibility of routine distress screening in tertiary cancer center in rural India

Dessai, Sampada; Chakraborty, Santam; Kumar, Priyank; Babu, Sajith; Muttath, Geetha; Nair, Chandran K.; Thiagarajan, Shivakumar; Sughosh, Biji; Bhattacharjee, Atanu; Patil, Vijay

doi:10.1002/pon.3739

Cited by 10 publications

(12 citation statements)

References 8 publications

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“…Patient distress especially has been related to a higher rate of noncompliance with medical advice. 38 A study by Dessai et al 39 at a rural Indian cancer center highlighted the high rates of actionable distress (41.0%) among patients with cancer. The patient-to-physician ratio is poor in India, affecting the amount of time spent on communication.…”

Section: Discussionmentioning

confidence: 99%

Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance

Patil¹,

Noronha²,

Joshi³

et al. 2015

JGO

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PurposeApproximately 15% to 20% of our patients with head and neck cancer receiving neoadjuvant chemotherapy (NACT) discontinue therapy because of various nonmedical reasons. We sought to analyze the factors associated with treatment default and noncompliance among these patients.Patients and MethodsWe performed a retrospective analysis of patients with T4 oral cancer treated with NACT between January 2011 and December 2012. We included patients who discontinued treatment for nonmedical reasons before the second cycle of NACT. The factors analyzed were income, education, socioeconomic status, age, sex, place of residence, habits, and payment pattern (government supported or personal capacity). Pearson χ2 test was used to identify significant factors associated with noncompliance.ResultsOf 486 patients, 91 patients (18.7%) were noncompliant. Percentages of noncompliant patients in the age groups < 30, between 30 and 60, and > 60 years were 25.0%, 17.4%, and 25.5%, respectively (P = .27). Percentages of noncompliance in patients residing within the city, same state, or different state were 20.7%, 20.9%, and 17.1%, respectively (P = .44). Noncompliance rates were 20.3%, 15.7%, 18.1%, and 22.5% in upper middle, lower middle, upper lower, and lower economic strata, respectively (P = .60). Similarly, there was no significant difference in noncompliance according to occupation, education level, payment pattern, sex, or habits.ConclusionOur analysis failed to identify any specific significant factor associated with noncompliance with NACT among our patients with T4 oral cancers.

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Section: Discussionmentioning

confidence: 99%

Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance

Patil¹,

Noronha²,

Joshi³

et al. 2015

JGO

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“…Furthermore, > 80% of patients with high distress scores had emotional problems, nearly 50% had practical problems, and all patients (100%) had physical problems. 6 These data stressed the need to consider distress screening in routine practice. Patients with head and neck cancer who are undergoing palliative chemotherapy frequently have physical symptoms, disfigurement, and disablement and are socially isolated.…”

Section: Introductionmentioning

confidence: 99%

“…Routine distress screening may not be feasible in developing nations because of limited manpower resources. 6 A clinical psychologist may not be available in each cancer site’s outpatient department. Furthermore, in centers with a high patient load, it is not feasible for each patient with high distress to be counseled by a psychologist in routine practice.…”

Section: Introductionmentioning

confidence: 99%

Distress Management in Patients With Head and Neck Cancer Before Start of Palliative Chemotherapy: A Practical Approach

Patil

Noronha

Joshi

et al. 2018

JGO

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PurposeThis study reports the incidence of distress, the factors associated with distress, and a practical strategy to resolve distress in patients with head and neck cancer who are starting palliative chemotherapy.MethodsAdult patients with head and neck cancer planned for palliative chemotherapy underwent distress screening before the start of treatment as part of this single-arm prospective study. Patients who had a distress score > 3 on the National Comprehensive Cancer Network (NCCN) distress thermometer were counseled initially by the clinician. Those who continued to have high distress after the clinician-led counseling were referred to a clinical psychologist and were started on palliative chemotherapy. After counseling, distress was measured again. The relation between baseline distress and compliance was tested using Fisher's exact test.ResultsTwo hundred patients were enrolled, and the number of patients with high distress was 89 (44.5% [95% CI, 37.8% to 51.4%]). The number of patients who had a decrease in distress after clinician-led counseling (n = 88) was 52 (59.1% [95% CI, 48.6% to 68.8%]) and after psychologist-led counseling (n = 32) was 24 (75.0% [95% CI, 57.6% to 72.2%]; P = .136). Compliance rates did not differ between the patients with or without a high level of distress at baseline (74.2% v 77.4%, P = .620).ConclusionThe incidence of baseline distress is high in patients awaiting the start of palliative chemotherapy. It can be resolved in a substantial number of patients using the strategy of clinician-led counseling, with additional referral to a clinical psychologist as required. Patients with a greater number of emotional problems usually require psychologist-led counseling.

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“…Dessai et al has highlighted the problems of routine distress screening in such institutes. 26 In a single-day pilot study, with an incentive for the oncologists, distress screening could be offered to only 85% of patients. Lack of manpower for screening was the single most important hindrance for distress screening.…”

Section: Discussionmentioning

confidence: 99%

A cross-sectional audit of distress in patients undergoing adjuvant therapy or follow-up in central nervous system malignancies

Patil

Malhotra

Tonse

et al. 2018

Neuro-Oncology Practice

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Background Unaddressed high distress leads to noncompliance with treatment, negatively affects quality of life, and may also have a negative impact on the prognosis of cancer patients. Patients with brain tumors have higher levels of distress than the general population and hence we hypothesize that even routine visits during adjuvant treatment or follow-up are likely to be stressful. This analysis was performed to identify the incidence of distress and factors affecting it. Methods This was an audit of 84 consecutive patients seen in an adult neuro-medical oncology outpatient department who were either receiving adjuvant chemotherapy or were on follow-up. Distress screening with the National Comprehensive Cancer Network (NCCN) distress thermometer was performed. Patients in whom distress was scored as 4 or above were considered as having high distress. Descriptive statistics and logistic regression analysis were performed to identify factors affecting distress. Results The median age of the cohort was 40 years (interquartile range, 28.3 to 50 years). Actionable distress defined as a distress score of 4 or more was seen in 52 patients (61.9%, 95% CI 51.2% to 71.5%). Presence of physical deficit (odds ratio [OR] = 3.412, P = .020) and treatment under the private category (OR = 5.273, P = .003) had higher odds of having high distress. Conclusion A high proportion of brain tumor patients either on adjuvant chemotherapy or on follow-up have high distress levels that need to be addressed even during follow-up.

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Pilot study of single‐day distress screening with the NCCN distress thermometer to evaluate the feasibility of routine distress screening in tertiary cancer center in rural India

Cited by 10 publications

References 8 publications

Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance

Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance

Distress Management in Patients With Head and Neck Cancer Before Start of Palliative Chemotherapy: A Practical Approach

A cross-sectional audit of distress in patients undergoing adjuvant therapy or follow-up in central nervous system malignancies

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