Implementing a Distress Screening Process for Cancer Patients

The impact of a cancer diagnosis on a patient’s emotional and psychological well-being has the potential to affect treatment response and adherence, as well as quality of life.¹ New cancer diagnoses and deaths are estimated to number 1 665 540 and 585 720, respectively, in a 1-year period.² In addition, an estimated 13.7 million Americans are undergoing curative or palliative treatments for cancer or being monitored closely as cancer free.³ Patients face times of remission intermingled with times of active treatment or metastatic disease. Patients with cancer have different experiences and challenges when coping with the disease, and assessment of issues defined as psychosocial distress is paramount in oncology settings.⁴

The National Comprehensive Cancer Network (NCCN), defines psychosocial distress as “an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. It extends along a continuum, from common normal feelings of vulnerability, sadness, and fears, to problems that are disabling, such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis.”⁵

Because psychosocial distress is a significant issue for patients with cancer, the Institute of Medicine made psychosocial care an integral part of cancer care in its report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, with an imperative to implement assessment plans.^6-8 Likewise, the American College of Surgeons agreed that holistic care, including a psychosocial standard, be phased into cancer care by 2015.⁹ More recently, the NCCN recommended changing the term to simply distress to reduce stigma and increase the likelihood for self-reporting.¹⁰

DEFINING OUR POPULATION AND ITS NEEDS

Patients with cancer should be screened for distress at least once during a pivotal point in their cancer journey.¹¹ Each facility can choose the time when a screening should occur.

Statement of the Problem Over the last 2 decades, with advances in detection and treatment of cancer, survival rates have increased.¹⁰ With this improvement in survival, there are now long-term side effects that can contribute to distress symptoms.¹² Patients struggle with financial, social, physical, psychosocial, and spiritual concerns are documented.¹³

Purpose The purpose of this project was to implement distress screening in both the hospital and community care settings and use sample results to identify distress levels and common problems patients experience. In this study, we addressed 3 questions.

• Do patients who report a distress score of 5 or higher have a greater number of problems than those who report a distress score of 4 or lower?
• Is cancer-related distress scored differently by patients’ gender, age, and cancer type?
• Does the cancer-related distress score correlate to the number of treatments received?