Usefulness of pharmacist‐assisted screening and psychiatric referral program for outpatients with cancer undergoing chemotherapy

Abstract

Objective: Major depressive disorder (MDD) and adjustment disorder (AD) are common psychiatric disorders in cancer patients but are often overlooked in clinical oncology settings. We introduced a clinical screening program utilizing the Distress and Impact Thermometer (DIT) to identify MDD and AD in cancer outpatients receiving chemotherapy. This study assessed the usefulness of the screening program.Methods: Pharmacists administered the DIT to consecutive patients undergoing chemotherapy at an outpatient clinic. Psychiatric treatment was recommended to all the patients with positive screening results. The proportion of patients referred to the Psychiatric Service during the program period was then compared with that during a usual care period.Results: Of the 520 patients who started chemotherapy during the 6-month program period, 5.0% (26/520) were referred to the Psychiatric Service and 2.7% (15/520) were diagnosed as having MDD or AD. No statistically significant difference in the referral rates was observed between the two periods (2.7 vs 1.0%, p 5 0.46). However, the period from the first chemotherapy treatment until the visit to the Psychiatric Service was significantly shorter during the program period than during the period of usual care (12.9713.2 days vs 55.6717.6 days, po0.001).Conclusions: The proportion of patients referred to the Psychiatric Service for the treatment of MDD or AD during the program period was not different from that during the usual care period. However, the program was useful for introducing psychiatric treatment at an earlier stage. Further modifications to the program to improve the referral rate are necessary.

Effects of Integrated Psychosocial Care for Distress in Cancer Patients

“…One study targeted breast cancer patients (17), while another examined breast and lung cancer patients (19); the others, however, examined mixed populations of cancer patients, and the sample sizes ranged from 60 (29) to 998 (24). Five studies used the Distress Thermometer (DT) (19,22) or the Distress and Impact Thermometer (20,23,24), which is a modified version of the DT (31), as a screening instrument; four studies (30) were also used in one study each.…”

Effects of screening for psychological distress on patient outcomes in cancer: A systematic review

“…Six studies [55][56][57][58][59][60] did not use a defined cutoff score to indicate a positive screen for heightened distress or to determine which patients would receive further assessment or treatment. In addition, 6 of the studies [58,[60][61][62][63][64] were not RCTs, but were, for example, sequential cohort designs. Finally, 3 of the studies [62][63][64] did not assess distress as an outcome, but investigated other outcomes, such as referral rates.…”

“…In addition, 6 of the studies [58,[60][61][62][63][64] were not RCTs, but were, for example, sequential cohort designs. Finally, 3 of the studies [62][63][64] did not assess distress as an outcome, but investigated other outcomes, such as referral rates.…”

Removing the Stress from Selecting Instruments: Arming Social Workers to Take Leadership in Routine Distress Screening Implementation

“…Another benefit of the DT is that it is available at no cost, after obtaining permission from the NCCN (2012). Finally, the DT has been successfully adapted for use across multiple languages and cultures (Absolom et al, 2011;Akizuki et al, 2003;Dolbeault, Boistard, Meuric, Copel, & Brédart, 2011;Grassi et al, 2011;Ito et al, 2011;Vodermaier et al, 2009) and is suitable to administer to low-literacy, often more vulnerable, patients.…”