Distress screening in cancer survivorship.

197 Background: Cancer survivors have physical, psychosocial, emotional and financial needs that vary in prevalence and may differ from needs of patients on active cancer treatment. Distress screening is mandated for cancer program accreditation and identifies, addresses and monitors the needs of patients. There is a paucity of data on the clinical application of distress screening among survivors. We used a validated distress screening tool to conduct a needs assessment of cancer survivors in the solid oncology clinic. Methods: The Cancer Support Source Distress Screening tool is an 18-item questionnaire given to patients on their 2nd and every 3 month medical oncology clinic visit to assess depression and distress. We merged patient survey data (patients completing ≥ 2) with the cancer registry to identify cancer survivors from July 2015 to October 2018. We performed bivariate and multivariate analysis evaluating change in depression and distress scores over time. Results: 92 patients were identified. The table indicates changes in depression and distress scores by cancer. Depression scores improved for most cancer types with an improvement in distress scores across all cancers. Emotional/mental health, communication, provider relationship, system of care, body image and social support were associated with significant changes in survivorship concern. We are completing a multivariate analysis controlling for sociodemographic factors to evaluate change in depression and distress scores across the survivorship trajectory. Conclusions: A distress screening survey may be a useful tool in assessing the unmet needs of cancer survivors. Identifying prevalent domains of survivorship issues can highlight areas of greatest perceived need and can guide quality improvement initiatives within a cancer program. [Table: see text]

Download Full-text

Distress screening in cancer survivorship.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.138 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 138-138

Author(s):

Julia P. Brockway-Marchello ◽

Haley Hines Theroux ◽

Sophia Tsesmelis Piccolino ◽

Qiuchen Yang ◽

Cardinale B. Smith

Keyword(s):

Multivariate Analysis ◽

Cancer Survivors ◽

Screening Tool ◽

Descriptive Analysis ◽

Clinic Visit ◽

Solid Cancer ◽

Distress Screening ◽

Cross Sectional ◽

Data Set ◽

Cancer Support

138 Background: Cancer survivors have varied physical, psychosocial, emotional and financial needs that may differ from needs of active cancer treatment patients. Distress screening identifies and monitors the needs of patients and is mandated for certain accreditations. There is a paucity of data on the application of distress screening among survivors. We used a validated distress screening tool to conduct a needs assessment of cancer survivors in solid oncology. Methods: The Cancer Support Source Distress Screening tool is an 18-item survey given on the 2nd and every 3-month clinic visit to assess depression and distress. The first analysis, merged patient data (patients completing ≥ 2) with cancer registry to identify solid cancer survivors from July 2015 to October 2018. A descriptive analysis of these patients was performed. The second analysis was cross-sectional with a larger data set of all solid tumor patients completing a survey at any time pre, during, or post treatment. We compared distress and depression scores using analysis of variance. A bivariate and multivariate analysis evaluating change in depression and distress scores over time is ongoing. Results: In analysis one, 92 patients were identified. Depression scores improved for most cancer types; distress scores improved for all cancers. Emotional, communication, provider relationship, system of care, body image and social support were associated with significant changes in survivorship concern. In the expanded dataset, 908 patients were identified. The distribution of depression and distress scores are shown in the table. There was a significant decrease for depression scores (p<.001) and distress scores (p<.001). Multivariate analysis to evaluate change in depression and distress scores across the survivorship trajectory is ongoing. Conclusions: A distress screening survey may be a useful tool in assessing the unmet needs of cancer survivors. Identifying prevalent domains of survivorship issues can highlight areas of greatest perceived need and can guide quality improvement initiatives within a cancer program. [Table: see text]

Download Full-text

Discriminatory power of a 25-item distress screening tool CancerSupport Source: A cross-sectional study of 251 cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9599 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9599-9599

Author(s):

Melissa F Miller ◽

C. Daniel Mullins ◽

Ebere Onukwugha ◽

Christopher Gayer ◽

Mitch Golant ◽

...

Keyword(s):

Cancer Survivors ◽

Screening Tool ◽

Psychosocial Care ◽

Summary Score ◽

Discriminatory Power ◽

Support Network ◽

Distress Screening ◽

Cross Sectional ◽

Study Objective ◽

Cancer Support

9599 Background: Distress screening and integrated psychosocial care is imperative for cancer patients, yet no tools are specifically tailored for the community provider setting where the majority of US patients are treated. Any screening tool must be validated and effective at discriminating those at risk for greater distress and the associated poorer health outcomes. The study objective was to test the discriminatory power of a 25-item distress screening tool CancerSupportSource for use among cancer survivors. Methods: A total of 251 members (90% female, median age 57 years; mixed diagnoses, 46% breast, 9% gynecologic, 7% blood, 6% colorectal, 32% other) of a community-based cancer support network completed a web-based distress screening tool. Participants were asked to rate each of 25 items according to the question “Today, how concerned are you about…?” using a five-point scale (0 not at all to 4 very seriously concerned). A summary score was calculated as the count of items rated ≥2 and the item discrimination index (IDI) as the difference between proportions of high and low scorers rating an item≥2. Cut-points at 13 and 4 yielded equal-sized groups and were used to classify participants as high (n=59) and low scorers (n=60). Results: Items with the greatest discriminatory power (IDI≥0.8) were: changes or disruptions in work, school or home life; worrying about the future and what lies ahead; feeling too tired to do the things you need or want to do; feeling sad or depressed; ability to exercise or be physically active; and feeling nervous or afraid. Conversely, items with the lowest IDI included: eating and nutrition; tobacco or substance use; transportation to treatment and appointments; considering taking your own life. Conclusions: The results highlight, among 25 items of a distress screening tool, those items with the greatest discriminatory power to identify cancer survivors with psychosocial distress. Results suggest priority areas for distress screening and referral for support services.

Download Full-text

Cancer-related distress and unmet needs among newly diagnosed and longer-term cancer survivors from a community-based distress screening program.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.220 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 220-220 ◽

Cited By ~ 2

Author(s):

Joanne S. Buzaglo ◽

Melissa F Miller ◽

Victoria Kennedy ◽

Margaret Longacre ◽

Mitch Golant ◽

...

Keyword(s):

Health Care ◽

Cancer Survivors ◽

Screening Tool ◽

Unmet Needs ◽

Health Care Team ◽

Care Team ◽

First Year ◽

Newly Diagnosed ◽

Distress Screening ◽

Cancer Support

220 Background: As survival rates increase among cancer patients, quality of life needs become more salient. Cancer Support Source (CSS) is a distress screening, referral and follow up program that uses a validated distress screening tool and referral algorithm to link cancer patients to resources tailored to their needs. The objective of this study was to describe psychosocial concerns and unmet needs at different times since cancer diagnosis. Methods: English speaking cancer survivors (n = 905) across 26 affiliates of a nationwide cancer support organization participated in the CSS program by first completing a screening tool, including a 4 item depression subscale. Participants rated the level of concern (0 to 4) about 15 items and identified the help they wanted for each item (talk with a member of your health care team and/or connect you with online resources). We used regression analysis, adjusting for age, to examine differences by time since diagnosis ( < 1 y; ≥ 1 y) in level of distress; type of concerns (rated ≥ 2); and items selected to talk with the health care team. Results: The sample was 78% female, 10% Latino, 9% Black, and median age 57 y. 41% were breast cancer survivors, 6% lung, and 6% colorectal. More than half were within 1 y of their diagnosis (61%, n = 507); 39% ≥ 1 y (n = 331). Those newly diagnosed ( < 1 y) had significantly higher levels of distress (p = 0.011); increased risk for depression (p = 0.007); and more likely to be concerned about changes in work, school, or home life; body image; feeling nervous or afraid; worry about the future; and making a treatment decision (p < 0.05). Among those who indicated that an item was a concern, newly diagnosed patients were significantly more likely to want to talk to their health care team about pain; financial worries; exercising; feeling lonely or isolated; feeling nervous or afraid; and worry about the future (p < 0.05). Conclusions: These findings suggest that patients are more distressed and more likely to want to talk about their psychosocial needs within the first year of a cancer diagnosis. Future research should evaluate efforts to provide tailored resources within the first year of a diagnosis when distress levels are highest.

Download Full-text

Development and validation of self- and caregiver-report of a distress screening tool for pediatric cancer survivors

Supportive Care in Cancer ◽

10.1007/s00520-019-04708-1 ◽

2019 ◽

Vol 27 (11) ◽

pp. 4179-4187

Author(s):

Soo Jin Yoon ◽

Kyong-Mee Chung ◽

Jung Woo Han ◽

Seung Min Hahn ◽

Sun Hee Kim ◽

...

Keyword(s):

Cancer Survivors ◽

Pediatric Cancer ◽

Screening Tool ◽

Distress Screening ◽

Pediatric Cancer Survivors ◽

Caregiver Report ◽

Development And Validation

Download Full-text

HSR19-100: CancerSupportSource®-15: Development and Evaluation of a Short Form of a Distress Screening Program for Cancer Survivors

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7160 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. HSR19-100

Author(s):

Shauna McManus ◽

Alexandra K. Zaleta ◽

Melissa F. Miller ◽

Joanne S. Buzaglo ◽

Julie S. Olson ◽

...

Keyword(s):

Factor Analysis ◽

Confirmatory Factor Analysis ◽

Cancer Survivors ◽

Psychometric Properties ◽

Internal Consistency ◽

Short Form ◽

Distress Screening ◽

Cancer Support ◽

Confirmatory Factor ◽

Item Quality

Background: CancerSupportSource (CSS) is a 25-item distress screening tool implemented at community-based cancer support organizations and hospitals nationwide. CSS assesses distress over 5 domains: (1) emotional concerns (including depression and anxiety risk screening subscales), (2) symptom burden, (3) body and healthy lifestyle, (4) healthcare team communication, and (5) relationships. This study developed a short form of CSS and examined its psychometric properties. Methods: 2,379 cancer survivors enrolled in the Cancer Support Community’s Cancer Experience Registry. Participants provided demographic and clinical background and completed CSS-25 and PROMIS-29, a measure of health-related quality of life. Item reduction was conducted with a subsample of 1,435 survivors and included external item quality (correlations between items and PROMIS-29 scales), internal item quality (inter-item and inter-factor correlations, factor loadings and structure, and item communalities from an exploratory factor analysis of CSS-25), and professional judgement (ranking/prioritization of items by CSS-25 developers, accounting for theoretical and practical implications). Pearson correlations and confirmatory factor analysis were conducted on a separate subsample of 944 survivors to corroborate psychometric properties and dimensionality of the shortened scale. Results: Scale refinement resulted in a 15-item short form of CSS (CSS-15). At least 1 item from each of the 5 CSS-25 domains was retained to preserve multidimensionality, including anxiety and depression risk screening subscale items. Additionally, 1 item about tobacco/substance use was kept due to clinical significance for risk assessment. In confirmatory factor analysis, the model explained 59% of the variance and demonstrated good fit (RMSEA=0.068, 90% CI=0.061–0.075; SRMR=0.033; CFI=0.959; χ2(68)=334.75, P<.001). Correlation between CSS-15 and CSS-25 was 0.986, P<.001. Total distress was associated with PROMIS subscales (rs=−.65–.75, ps<.001); internal consistency reliability was excellent (α=.92). Conclusions: CSS-15 is a brief, reliable, and valid multidimensional measure of distress. The reduced measure retained excellent internal consistency and a stable factor structure, while correlating well with CSS-25 and PROMIS-29. CSS-15 can serve as a practical tool to efficiently screen for distress among cancer patients and survivors.

Download Full-text

Discriminatory power of a 25-item distress screening tool: a cross-sectional survey of 251 cancer survivors

Quality of Life Research ◽

10.1007/s11136-014-0742-4 ◽

2014 ◽

Vol 23 (10) ◽

pp. 2855-2863 ◽

Cited By ~ 2

Author(s):

Melissa F. Miller ◽

C. Daniel Mullins ◽

Eberechukwu Onukwugha ◽

Mitch Golant ◽

Joanne S. Buzaglo

Keyword(s):

Cancer Survivors ◽

Screening Tool ◽

Discriminatory Power ◽

Distress Screening ◽

Cross Sectional Survey ◽

Cross Sectional

Download Full-text

Psychooncological distress in low-grade glioma patients—a monocentric study

Acta Neurochirurgica ◽

10.1007/s00701-021-04863-7 ◽

2021 ◽

Author(s):

Alessandra Ley ◽

Marcel Kamp ◽

Christiane von Sass ◽

Daniel Hänggi ◽

Michael Sabel ◽

...

Keyword(s):

Depression Scale ◽

Sociodemographic Factors ◽

Low Grade Glioma ◽

Screening Tools ◽

Histopathological Diagnosis ◽

Low Grade ◽

Distress Screening ◽

Clinical Trial Registration ◽

Eortc Qlq C30 ◽

Eortc Qlq

Summary Background Patients diagnosed with low-grade glioma (LGG) must live with constant knowledge of an upcoming malignant tumor transformation which may lead to increased anxiety and reduced quality of life. Here, we (1) analyzed the prevalence and risk factors for distress in LGG patients using (2) different screening tools to subsequently (3) evaluate their need for psychological support. Method Patients with LGG-suspicious findings in MRI studies as well as patients with histopathological confirmed LGG were screened using three established self-assessment instruments (Hospital Anxiety and Depression Scale, Distress Thermometer, EORTC-QLQ-C30-BN20). Screening results were correlated with sociodemographic factors. Results One hundred forty-nine patients (74 men and 75 women) were prospectively included. Patients were further divided into different subgroups regarding the time of screening and diagnosis. An increased level of distress was observed in 20.8% (mean score 1.21, 95% CI 1.15–1.28) of all patients screened by HADS. Significant associated factors were pre-existing psychiatric disorders (p = 0.003) and psychotropic medication (p = 0.029). HRQoL (p = 0.022) and global health item (p = 0.015), as well as future uncertainty (p = 0.047), assessed by the EORTC-QLQ-C30-BN20 were significantly higher in those patients without histopathological diagnosis. Increased distress was significantly correlated with results in chosen sub-items of the HRQoL questionnaire (p < 0.001). Conclusions Our results demonstrate the need for frequent distress screening. If specific tools are not available, HRQoL questionnaires can also be used. Patients with pre-existing psychological stress should be offered additional psychooncological support, irrespectively of the time of screening or tumor diagnosis. Clinical trial registration number: 4087

Download Full-text

Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada

Current Oncology ◽

10.3390/curroncol28010004 ◽

2020 ◽

Vol 28 (1) ◽

pp. 13-25

Author(s):

Soleil Chahine ◽

Gordon Walsh ◽

Robin Urquhart

Keyword(s):

Primary Care ◽

Nova Scotia ◽

Cancer Survivors ◽

Sociodemographic Factors ◽

Patient Navigator ◽

Care Providers ◽

Psychosocial Needs ◽

Factors Associated ◽

Follow Up Care

Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.

Download Full-text

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.235 ◽

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 < 0.001) and DT (r = 0.58, p < 0.001), while there was a slightly smaller association with Mayo score (r = 0.46, p < 0.001) and HBI (r = 0.39, p < 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.

Download Full-text