Distress Assessment

No one would argue that being diagnosed with cancer and undergoing cancer treatment is stressful. Clinicians also would agree that it’s important to assess psychosocial distress associated with treatment and intervene when necessary. With few exceptions, there are a vast array of psychosocial services available to patients within their treatment facilities and communities. There also is a great deal of online support from organizations such as the American Cancer Society, National Cancer Institute, LiveStrong, etc. The logical conclusion here is that psychosocial services are widely available, so all we need to do is assess and refer.

Unfortunately, that’s not what researchers in the United Kingdom found when they evaluated whether distress monitoring and needs assessment using the Distress Thermometer and Problem List (DT&PL) improved patient outcomes. They conducted an un-blinded, two-arm, parallel randomized controlled trial at two sites where patients were starting radiotherapy or chemotherapy. The intervention group completed the DT&PL, and rated distress and discussed sources of distress with a trained radiotherapy technician or nurse. No specific triage algorithms were followed and the control group received usual care. The main outcome measure was psychological distress (Profile of Mood States [POMS], short form) up to 12 months; secondary outcomes were quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30) and health care costs.

Of 220 patients randomly assigned, 112 patients were allocated to the DT&PL and 95% completed the primary outcome at 12 months. A third of patients had high levels of distress, and most reported physical (84%) or emotional (56%) problems. There was no evidence of an effect of the DT&PL on adjusted POMS scores over follow-up or in secondary outcomes. The DT&PL costs $28 per patient and did not lower subsequent health care costs. Few patients (< 3%) in either arm of the trial were referred to a clinical psychologist. Although this study was conducted in the United Kingdom, it makes us aware of the need to assess our own institutions to determine how often patients are referred for supportive care services when distress has been identified.

Reference

Hollingsworth W, Metcalfe C, Mancero C, et al. Are Needs Assessments Cost Effective in Reducing Distress Among Patients with Cancer? A randomized Controlled Trial Using the Distress Thermometer and Problem List. JCO 2013; published online ahead of print, doi: 10.1200/JCO.2012.48.3040.