Patients undergoing treatment for cancer who receive distress screening and follow-up tend to visit emergency rooms and be hospitalized less often than patients not provided with those resources, according to a study published in the Journal of the National Comprehensive Cancer Network (JNCCN).1
Two decades ago, the NCCN developed consensus-based guidelines to help health care professionals identify and treat patients with cancer who were in psychosocial distress. In 2007, the American College of Surgeons' Commission on Cancer (CoC) established new accreditation standards for patient-centered care, including a mandate requiring that all patients be screened for distress and that there be an appropriate clinical response when patients are identified as distressed.
In 2009, the International Psycho-Oncology Society stated that distress should be added to the list of vital signs used to assess patients,2 in addition to temperature, blood pressure, pulse, respiration, and pain. It is known that severe and untreated distress can have a significant impact on health outcomes; however, recent research has found that screening for distress is not occurring in all facilities and patients are not receiving the treatment and follow-up they need.
For the JNCCN study, researchers from Michigan, Kentucky, Georgia, Maryland, and Illinois looked at various cancer programs and whether protocols of outreach and follow-up were adhered to, and also examined their association with how patients used emergency and hospital services.
“Appropriate screening and identification of distress would flag a referral to a social worker, whose clinical assessment would uncover the cause of the patient’s distress and lead to clinical engagement and delivery of an appropriate, evidence-based intervention, complementary to clinical treatment,” said lead author Brad Zebrack, PhD, MSW, MPH.
Examples of distress include financial difficulty, family conflict, substance abuse, or any issue that causes anguish. Patients who do not initially experience distress may do so later in treatment, reinforcing why screening throughout treatment is important. The NCCN has published guidelines3 for patients that provide information on what distress is, as well as specific triggers, screening tools, and more.
For this study, oncology social workers at CoC-accredited cancer programs reviewed 8,409 electronic health records across 55 cancer centers in their respective cancer programs during a 2-month period in 2014. They calculated rates of overall adherence to a prescribed distress screening protocol and if an appropriate clinical response had occurred. They then looked at emergency department use and hospitalization after patients had been screened.
The results showed an overall adherence rate to screening protocols of 62.7%; the highest rates of adherence were observed in community cancer programs (76.3%) and the lowest rates in National Cancer Institute–designated cancer centers (43.3%). The rates of medical service use were significantly higher than expected when overall protocol adherence was lacking.
Regardless of care setting, adherence rates for adolescent and young adult patients (15 to 39 years old) were significantly lower (58%) when compared with other age populations. The highest adherence rates (70%) were among African American patients, while the lowest adherence rates (45%) were found in patients of American Indian/Alaska Native/Native Hawaiian/Pacific Island descent.
The researchers noted that when overall protocol adherence was documented, 18% to 19% fewer patients used these emergency and hospital services.
“Particularly concerning is the finding that documentation of psychosocial screening in one of every three cases in this sample is lacking. The absence of these clinical data can compromise the ability of oncology care providers to know whether patients are receiving the psychosocial care and support they need,” Zebrack said.
1. Zebrack B, Kayser K, Bybee D, et al. A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization. J Natl Compr Canc Netw. 2017;15:903-12.
2. Lazenby M, Tan H, Pasacreta N, et al. The five steps of comprehensive psychosocial distress screening. Curr Oncol Rep. 2015;17:447.
3. National Comprehensive Cancer Network. NCCN Guidelines for Patients: Distress. Version 1, 2017. https://www.nccn.org/patients/guidelines/distress/files/assets/common/downloads/files/distress.pdf