Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21644-e21644
Author(s):  
Julia Rachel Trosman ◽  
James Gerhart ◽  
Urjeet Patel ◽  
Paramjeet Khosla ◽  
Patricia A. Robinson ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Screening Tool ◽  
Specific Treatment ◽  
Safety Net ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Distress Screening ◽  
Care Needs ◽  
Supportive Oncology

e21644 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, nutritional and specific treatment/care concerns, and lower physical function (p<.0001). Conclusions: Patients with higher anxiety and depression also have many other supportive oncology concerns. Our results support the use of a comprehensive tool capturing a spectrum of each patient’s unique concerns. This may enable earlier interventions and personalized delivery of supportive care. [Table: see text]

Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 61-61
Author(s):  
Paramjeet Khosla ◽  
Julia Rachel Trosman ◽  
James Gerhart ◽  
Urjeet Patel ◽  
Shelly S. Lo ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Screening Tool ◽  
Specific Treatment ◽  
Safety Net ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Distress Screening ◽  
Care Needs ◽  
Supportive Oncology

61 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, , nutritional and specific treatment/care concerns, and lower physical function (p<.0001). (See Table). Conclusions: Patients with higher anxiety and depression also have many other supportive oncology concerns. Our results support the use of a comprehensive tool capturing a spectrum of each patient’s unique concerns. This may enable earlier interventions and personalized delivery of supportive care. [Table: see text]

A consolidated screening tool for supportive oncology needs and distress.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 72-72
Author(s):  
Amy Scheu ◽  
Lauren Allison Wiebe ◽  
Shelly S. Lo ◽  
Catherine Deamant ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Screening Tool ◽  
Safety Net ◽  
Screening Tools ◽  
Distress Screening ◽  
Chicago Area ◽  
Oncology Care ◽  
Screening Questions ◽  
Supportive Oncology ◽  
The Right ◽  
Patient Centric

72 Background: The IOM 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) standard 3.2 requires distress screening and indicated action. Screening tools are not standardized across institutions and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric consolidated screening tool based on validated instruments (NCCN Distress Problem List, PHQ-4, PROMIS) and IOM and CoC. The screening tool was piloted at 6 practice improvement cancer centers in the Chicago area (3 academic, 2 safety-net, 1 public). Patients, providers assessing each patient’s screening results (assessors), and providers receiving referrals (referral providers) were surveyed after each use of the screening tool. Descriptive statistics were used to assess effectiveness of the tool. Results: Responders included 29 patients, 81 assessors and 26 referral providers (SW, chaplain, subspecialist). The majority of patients (22/29, 75%) completed the screening in < 10 minutes without assistance and will complete at every visit. Most assessors (59/77, 76%) spent < 5 minutes reviewing screening results. The majority of patients, assessors, and referral providers reported that the screening tool asked the “right questions”. Assessors reporting partial relevance of some screening questions for 34% (26/77) of patients, uncovered ≥ 1 relevant needs for 96% (25/26) of those patients (p = 0.002). Conclusions: Use of a consolidated supportive oncology screening tool across multiple institutions is feasible, discovered unmet patient needs, and was beneficial for assessors and providers. As the tool is adopted by collaborating institutions, variations in supportive oncology screening may decline, thus improving access to supportive oncology care with implications for national dissemination. [Table: see text]

A consolidated screening tool for supportive oncology needs and distress.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 47-47
Author(s):  
Christine B. Weldon ◽  
Nancy Vance ◽  
Amy Scheu ◽  
Lauren Allison Wiebe ◽  
Shelly S. Lo ◽  
...  
Keyword(s):  
Screening Tool ◽  
Safety Net ◽  
Screening Tools ◽  
Quality Improvements ◽  
Distress Screening ◽  
Oncology Care ◽  
Screening Questions ◽  
Supportive Oncology ◽  
The Right ◽  
Improving Patient Care

47 Background: The IOM 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized across institutions and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric consolidated screening tool based on validated instruments (NCCN Distress, PHQ-4, PROMIS) and IOM and CoC. The screening tool was piloted at 6 practice-improvement cancer centers in the Chicago area (3 academic, 2 safety-net, 1 public). Patients, providers assessing patients’ screening results (assessors), and providers receiving referrals (providers) were surveyed after use of the screening tool. Descriptive statistics were used to assess effectiveness of the tool. Results: Responders included 175 patients, 81 assessors, and 26 referral providers (social workers, chaplains, subspecialists). The majority of patients (160/175, 91%) completed the screening in <10 minutes, across all patients the screening tool averaged 4 ½ minutes. Most assessors (59/77, 76%) spent <5 minutes reviewing screening results. Most patients, assessors, and providers reported the screening tool asked the “right questions”. Assessors reporting partial relevance of some screening questions for 34% (26/77) of patients, uncovered ≥ 1 relevant needs for 96% (25/26) of those patients (p = 0.002). Conclusions: Use of a consolidated supportive oncology screening tool across multiple institutions is feasible, identified unmet patient needs, and was beneficial for assessors and providers. As the tool is adopted by collaborating institutions, variability in supportive oncology screening practices may decline, thus improving patient care. The tool has implications for quality improvements and national dissemination. [Table: see text]

Correlates of distress for cancer patients: Results from multi-institution use of holistic patient-reported screening tool.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11587-11587
Author(s):  
Christine B. Weldon ◽  
James I. Gerhart ◽  
Frank J. Penedo ◽  
Paramjeet Khosla ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Cancer Patients ◽  
Screening Tool ◽  
Screening Tools ◽  
Distress Screening ◽  
Age Related ◽  
Distress Score ◽  
Patient Reported ◽  
Chi Squared

11587 Background: The Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action for cancer patients. NCCN and ASCO supportive care and age-related guidelines include patient reported concerns beyond distress. This study compares PHQ4 scores to other patient reported concerns. Methods: The Coleman Supportive Oncology Collaborative aggregated “best of” screening tools to assess patient reported needs and concerns aligned with CoC, NCCN and ASCO guidance. This supportive care screening tool was implemented at 8 sites from July 2015 thru July 2018. Analysis used chi squared test. Results: Most patients, 86% (10,635/12,295), reported one plus concerns and/or above threshold scores on PHQ4, PROMIS Pain, Fatigue or Physical Function. A chi squared comparison of patients with at least mild distress on PHQ4 to patients with no distress resulted in p values < .0001 for every screening category. Conclusions: Patients with a PHQ4 distress score of mild, moderate or severe also reported statistically significant levels of practical, family, physical, nutrition and treatment concerns. These patients also scored threshold levels for PROMIS Pain, Fatigue, and Physical Function. Screening only for distress without screening for other patient concerns may direct patients to services that do not address or focus on the underlying cause of the distress. [Table: see text]

Correlates of distress for cancer patients: Results from multi-institution use of holistic patient-reported screening tool.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 199-199
Author(s):  
Christine B. Weldon ◽  
James I. Gerhart ◽  
Frank J. Penedo ◽  
Mary Pasquinelli ◽  
Joanna Martin ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Cancer Patients ◽  
Screening Tool ◽  
Screening Tools ◽  
Distress Screening ◽  
Age Related ◽  
Distress Score ◽  
Patient Reported ◽  
Chi Squared

199 Background: The Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action for cancer patients. NCCN and ASCO supportive care and age-related guidelines include patient reported concerns beyond distress. This study compares PHQ4 scores to other patient reported concerns. Methods: The Coleman Supportive Oncology Collaborative aggregated “best of” screening tools to assess patient reported needs and concerns aligned with CoC, NCCN and ASCO guidance. This supportive care screening tool was implemented at 8 sites from July 2015 thru July 2018. Analysis used chi squared test. Results: Most patients, 86% (10,635/12,295), reported one plus concerns and/or above threshold scores on PHQ4, PROMIS Pain, Fatigue or Physical Function. A chi squared comparison of patients with at least mild distress on PHQ4 to patients with no distress resulted in p values < .0001 for every screening category. Conclusions: Patients with a PHQ4 distress score of mild, moderate or severe also reported statistically significant levels of practical, family, physical, nutrition and treatment concerns. These patients also scored threshold levels for PROMIS Pain, Fatigue, and Physical Function. Screening only for distress without screening for other patient concerns may direct patients to services that do not address or focus on the underlying cause of the distress. [Table: see text]

Incorporating geriatric patient reported outcomes into novel screening tool of distress and supportive care concerns.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 37-37
Author(s):  
James I Gerhart ◽  
Ana Gordon ◽  
Betty Roggenkamp ◽  
Paramjeet Khosla ◽  
Julia Rachel Trosman ◽  
...  
Keyword(s):  
Geriatric Patient ◽  
Patient Reported Outcomes ◽  
Screening Tool ◽  
Self Care ◽  
Specific Treatment ◽  
Average Score ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Patient Reported ◽  
Supportive Oncology

37 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative then revised the CSOC-ST tool to align with geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]

Incorporating geriatric patient-reported outcomes into novel screening tool of distress and supportive care concerns.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 198-198
Author(s):  
Christine B. Weldon ◽  
Joanna Martin ◽  
Amy Scheu ◽  
Paramjeet Khosla ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Geriatric Patient ◽  
Patient Reported Outcomes ◽  
Screening Tool ◽  
Self Care ◽  
Specific Treatment ◽  
Average Score ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Patient Reported ◽  
Supportive Oncology

198 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative revised the CSOC-ST tool to align with ASCO geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to ASCO geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]

scholarly journals P106 Depressive symptoms and anxiety and their screening in IBD patients: performance of the distress thermometer in Italian IBD patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
C Canaletti ◽  
F Colombo ◽  
A Dessì ◽  
E Geccherle ◽  
A Tongiorgi ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Emotional Distress ◽  
Screening Tool ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Cutoff Score ◽  
Distress Screening ◽  
Single Item ◽  
Mayo Score ◽  
Clinical Indices

Abstract Background Roughly 50% of patients with IBD have symptoms of psychological distress (Mikocka-Walus et al. 2019) but only 15.2% receive attention for their mental health although the effect on disease severity can be profound. It is necessary to have an easy-to-administer psychological distress screening tool. The distress thermometer (DT) is a single-item distress screening scale with 11-likert response widely used in oncological patients. The aim of study was to determine whether the single-item DT compared favourably with IBD clinical indices and time consuming measures currently used to screen for distress. Methods Two hundered and twenty IBD patients (51.43% male) who were recruited in eight Italian hospitals completed the DT and identified the presence or absence of 34 problems using standardised problem list (PL). They completed the 14-item Hospital Anxiety and Depression Scale (HADS) and the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ). Disease clinical indices have been collected for each patient (Mayo score, Harvey–Bradshaw Index–HBI, years of illness, and exacerbation in the last year). Using receiver operating characteristic (ROC) analyses validated the use of the DT in Italian IBD population. Results 47.6% reported anxiety and depression symptoms (HADS ≥15) and needs emotional care. Anxiety is much more associated (43.8%) than depressive problems (26.2%). Data are confirmed by responses to DT and PL: 44.5% of patients reported moderate–severe emotional distress (TD ≥ 5), 43.1% of patients report nervousness and worry, 27.1% reported depression. We observed a strong positive correlation between IBDQ and HADS (r = 0.74, p &lt; 0.001) and DT (r = 0.58, p &lt; 0.001), while there was a slightly smaller association with Mayo score (r = 0.46, p &lt; 0.001) and HBI (r = 0.39, p &lt; 0.001). There was not a statistical significant correlation between disease indices and the emotional distress as measured by HADS or DT. ROC analyses showed that a DT cutoff score of 5 or higher had optimal sensitivity (83%) and specificity (68%) relative to the HADS score as ‘gold’ standard. DT scores yielded area under the curve estimates relative to the HADS cutoff score indicative of good overall accuracy (AUC = 0.81–95% CI: 0.77–0.85). Conclusion Our study confirms that anxiety and depression symptoms are associated with IBD. This is the first study that demonstrated that DT is an easy-to-administer screening tool of psychosocial distress in IBD population. We propose that gastroenterologists use DT to identify patients with psychological distress: an early psychological support and a multidisclinar equipe can determinate a patient’s better disease course (Mawdsley et al. 2005). Our analyses indicated that using a DT’s cutoff of 5 to indicate high levels of distress.

Does chemotherapy reduce stress?

2010 ◽  
Vol 8 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Francisco Gil ◽  
G. Costa ◽  
F.J. Pérez
Keyword(s):  
Cancer Patients ◽  
Performance Status ◽  
Adjustment Disorder ◽  
Clinical Interview ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Chemotherapy Treatment ◽  
Psychological Care ◽  
Care Needs ◽  
Low Performance

AbstractObjective:The purpose of this study was to assess the psychological care needs of cancer patients throughout the healthcare process: after diagnosis, after medical treatment (surgery, chemotherapy, radiotherapy) and during follow-up.Method:A total of 703 ambulatory cancer patients were assessed in this study. The inclusion period was from April 1, 2005 to April 30, 2007. The first psychological scales used were the 14-item Hospital Anxiety and Depression Scales (HADS), which has two sub-scales for anxiety (7 items) and for depression (7 items). All patients with a score ≥14 were assessed through the Structured Clinical Interview for Psychiatric Disorder (SCID-I) of the DSM-IV. All data were compared with sociodemographic and medical characteristics.Results:Of the 703 cancer patients in the study, 349 were men and 354 women, with a mean age of 53 years. The median time between the cancer diagnosis and our clinical interview was 6 months (range, 12 days to 190 months). Overall, the screening tools indicated that one in four patients needed psychological care. The most common psychiatric diagnosis was adjustment disorder (129 cases), whereas 10 patients were diagnosed with major depression. Using a HADS cut-off score of >7 for anxiety and depression, 28% and 17% of patients, respectively, were classified as “possible clinical cases.” Risk factors for distress included age <65 years, asthenia, constipation, and a low performance status. However, chemotherapy treatment was found to be a protector against distress in cancer patients.Significance of Results:Chemotherapy treatment is interpreted by the patients as a protector against cancer, thereby reducing distress levels.

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