Implementing a Distress Screening Process for Cancer Patients

Distress level by number of problems Participants who scored their distress as 4 or lower (N = 40) reported fewer problems over the last week, with a mean score of 7.45 (range, 2-17). Participants who scored their distress as 5 or higher (N = 15) reported twice as many problems with a mean score of 14.4 (range, 4-21). Some participants scored their distress as a 5 or higher but reported fewer problems than those participants who scored their distress as a 4 or lower.

Distress level by demographics Most of our participants were females who also reported more distress during treatment than the male participants. Scores for both groups represented a wide range of distress. One male rated his distress as a 9 on the thermometer, and 1 female rated her distress at the highest score, 10 (Table 5).

TABLE 5. Distress Level by Participant Characteristic

	Mean (N)	Range
Gender
Male	2.7 (17)	0-9
Female	3.2 (38)	0-10
Age
26-35 years	6.0 (1)	6
36-45 years	0.6 (3)	0-1
46-55 years	5.3 (9)	1-10
56-65 years	4.1 (16)	0-9
66-75 years	1.7 (20)	0-6
>76 years	2.3 (6)	0-7

Most participants were age 66 to 75 years, and they reported the second-lowest distress scores. The groups reporting the highest distress scores were 26 to 35 years (mean distress score 6) and 46 to 55 years (mean distress score 5.3).

Mean distress scores for participants by cancer type were lung cancer, 4 (range 0-8 problems); breast cancer, 3.8 (range 0-9); head and neck cancer, 3.2 (range 2-6). Although only 4 participants had head and neck cancer, their distress ranked third among the cancer types represented in our study (Table 6).

TABLE 6. Distress Level by Cancer and Treatment Type

Type	Mean (N)	Range
Cancer Type
Breast	3.8 (14)	0-9
Lung	4.0 (10)	0-8
Colorectal	3.2 (9)	0-10
Prostate	2.0 (2)	0-4
Lymphoma	2.2 (4)	0-9
Renal Cell	4.0 (1)	4
Bone	0.0 (1)	0
Head and neck	3.2 (4)	2-6
Gynecologic	2.6 (3)	0-5
Multiple Myeloma	1.5 (2)	1-2
Leukemia	3.0 (1)	3
Myelodysplastic syndrome	0.0 (1)	0
Brain	0.0 (1)	0
Melanoma skin	2.0 (2)	1-3
Treatment Type
Radiation	3.8 (21)	0-10
Chemotherapy	2.6 (34)	0-9

Participants undergoing radiation therapy reported higher distress than those undergoing chemotherapy. Mean scores were 3.8 vs 2.6, respectively.

Distress level by treatment Among the participants who had undergone prior treatment with either radiation or chemotherapy, mean distress score was 3.8 (range 0-10). One participant reported receiving concurrent chemoradiation treatment and a distress score of 3. The participants with no prior treatment had a mean distress score of 2.5 (Table 7).

TABLE 7. Distress Level by Prior and Current Treatment

Treatment	Mean (N)	Range
Prior Treatment
Yes	2.5 (19)	0-8
No	3.8 (25)	0-10
Concurrent	3.0 (1)	3
Cannot remember	2.3 (10)	0-9
Number of Treatments
First cycle/week	3.7 (4)	2-5
Second cycle/week	5.8 (6)	1-10
Third cycle/week to halfway point	2.7 (11)	0-6
Halfway point to second-to-last cycle/week	3.5 (4)	0-9
Last cycle/week	3.4 (10)	0-8
Palliative till end of life	3.8 (5)	0-9
Cannot remember	1.6 (15)	3

Distress was further evaluated in relation to number of treatments. Participants reporting the highest level of distress (mean 5.8) were in their second cycle of chemotherapy or week of radiation treatment. This was a sharp increase compared with the mean distress score (3.7) of those in their first cycle/week of treatment. The lowest mean score (2.7) was for the third cycle/week to halfway point of treatment. At the halfway point and beyond, mean distress scores increased again to 3.5 and 3.4, respectively, for the halfway point to second-to-last cycle/week and the last cycle/week. Five participants reported receiving palliative treatment until end of life, and their mean score was higher (3.8).