Distress and Psychosocial Needs: Demographic Predictors of Clinical Distress After a Diagnosis of Cancer

Depression and Distress Screening in Oncology Patients: A Descriptive Analysis

This retrospective study aimed to describe the characteristics of cancer patients undergoing depression and distress screening at the Sidney Kimmel Cancer Center and to assess factors associated with their screening results. Data were retrieved from electronic medical records of adult Sidney Kimmel Cancer Center patients with at least one oncology encounter between January 2021 and June 2022, who underwent both depression and distress screening using the Patient Health Questionnaire-2/9 for depression and the National Comprehensive Cancer Network distress thermometer for distress during the encounter. Demographics, clinical factors, and screening results were analyzed using descriptive statistics and binary logistic regression. A total of 1954 cancer patients were screened for psychological needs. Of these, 110 (5.6%) screened positive for depression and 830 (42.5%) screened positive for distress. About 69.1% of patients who screened positive for depression also screened positive for distress. Conversely, 9.2% of patients who screened positive for distress also screened positive for depression. Cancer patients >65 years old were found significantly less likely to screen positive for both distress and depression, while males were found significantly less likely to screen positive for distress. African American patients were found to be significantly more likely than White patients to screen positive for both distress and depression (odds ratio: 2.58; confidence interval: 1:53-4.34). In this study, a higher proportion of cancer patients were found to be distressed than depressed, suggesting that the National Comprehensive Cancer Network distress thermometer may be a more useful tool in identifying psychosocial concerns in this population. Differences in depression and distress scores were significantly associated with age, sex, and race. These findings highlight the need for the implementation of effective screening strategies to better address the psychosocial needs of cancer patients. Further research is warranted to validate these findings and assess the impact of distress screening on patient outcomes across various oncology settings.

The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium

The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer.

Emotional Distress in Portuguese Cancer Patients: The Use of the Emotion Thermometers (ET) Screening Tool

Cancer patients may experience significant distress. The "Emotion Thermometers" (ETs) are a short visual analogue scale used to screen patients for psychosocial risk. This study aimed to assess emotional distress in a large sample of cancer patients attending psychological services at an non-governmental organization (NGO), and to explore factors that may contribute to it. The ETs were answered by 899 cancer patients. They were, on average, 59.9 years old, the majority were female, had breast cancer, were under treatment or were disease-free survivors, and reported high levels of emotional distress, above the cut-off (≥5). A Generalized Linear Model was used to measure the association between the level of distress, age, gender, disease phase and 33 items of the problem list. Four items-sadness, depression, sleep and breathing-were found to be significantly related to a higher level of distress. Additionally, women and patients who were in the palliative phase also had significantly higher levels of distress. The results confirm the need for early emotional screening in cancer patients, as well as attending to the characteristics of each patient. Additionally, they highlight the utility of the ETs for the clinical practice, allowing to optimize the referral to specialized psychosocial services.

Psychological impact of comprehensive tumor genomic profiling results for advanced cancer patients

OBJECTIVE

Comprehensive tumor genomic profiling (CTGP) is increasingly used to personalize treatments, providing hope, but potentially disappointment, for patients. We explored psychological outcomes in patients with advanced, incurable cancer, after receiving CTGP results.

METHODS

Participants with advanced, incurable cancer (n = 560, mean age 56, 43% university educated) in this longitudinal substudy of the Molecular Screening and Therapeutics Program (MoST), completed questionnaires before and after receiving CGP results. MoST participants, recruited from Australian oncology clinics, undergo CTGP, and if there are actionable findings, are offered treatment in a related therapeutic trial if available.

RESULTS

Patients who received actionable results, (n = 356, 64%) had lower gene-related distress (MICRA) (p < 0.001) and Impact of Events scores (p = 0.039) than patients with non-actionable results. Those with actionable results offered ensured access to tailored treatment (n = 151) reported lower anxiety (p = 0.002) and depressive symptoms (p = 0.01) and greater hope (p = 0.002) than those not offered. Positive attitudes towards uncertainty and higher self-efficacy for coping with results were associated with lower psychological distress and uncertainty, and higher hope and satisfaction with the decision to have CTGP (ps=0.001-0.047). Those with higher knowledge reported greater anxiety (p = 0.034).

CONCLUSION

Receiving a non-actionable CTGP result, or an actionable result without ensured access to treatment, may cause increased distress in advanced cancer patients. Coping style was also associated with distress.

PRACTICE IMPLICATIONS

Pre-testing assessment and counseling addressing attitudes toward uncertainty and self-efficacy, and post-CTGP result support for patients receiving a non-actionable result or who receive an actionable results without ensured access to treatment, may benefit patients.

Impact of the COVID-19 pandemic on cancer patients and psycho-oncology providers: Perspectives, observations, and experiences of the American Psychosocial Oncology Society (APOS) membership

OBJECTIVE

To understand: (1) psycho-oncology providersX2019; perspectives on and observations of the psychological responses of their cancer patients during the pandemic, and (2) psycho-oncology providersX2019; own experiences delivering care.

METHODS

In this concurrent mixed methods study, a survey was distributed to psychosocial providers who were members of the American Psychosocial Oncology Society (APOS). Survey respondents were invited to participate in a one-on-one audio-recorded interview via phone or secure ZoomX00AE;.

RESULTS

76 self-identified psycho-oncology providers responded to the survey and 11 participated in a one-on-one interview. Approximately half reported that patients responded in unique ways to COVID-19 stress relative to other populations. Three themes emerged from qualitative analyses: (1) unique burden on patients, (2) cancer patientsX2019; pandemic response and its relationship to their cancer experience, and (3) unexpected positive changes. Providers emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patientsX2019; resiliency. Two themes emerged regarding delivery of care: (1) new professional and personal challenges and (2) provider resiliency.

CONCLUSIONS

Although providers observed that the pandemic placed new burdens on patients, they emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patientsX2019; resiliency. To overcome challenges, psycho-oncology providers used innovative strategies to support patients and foster their own mental health. This article is protected by copyright. All rights reserved.

Prevalence of distress, its associated factors and referral to support services in people with cancer

AIMS AND OBJECTIVES

To (i) characterise prevalence of distress amongst people diagnosed with cancer, (ii) determine factors associated with increasing distress, (iii) describe reported problems for those with clinically significant distress and (iv) investigate the factors associated with referral to support services.

BACKGROUND

International studies report a high prevalence of clinically significant distress in people with cancer. Australian studies are notably lacking. Additionally, clinicians still do not fully understand the factors associated with cancer-related distress.

DESIGN

Period prevalence study.

METHODS

Distress screening data were analysed for 1,071 people accessing the Cancer Council Western Australia information and support line between 01/01/2016-31/12/2018. These data included people's demographics, cancer diagnoses, level of distress, reported problems and the service to which they were referred. Distress and reported problems were measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List. A partial proportional logistic regression model was constructed to determine which factors were associated with increasing levels of distress. Standard binary logistic regression models were used to investigate factors associated with referral to support services. The STROBE checklist was followed.

RESULTS

Prevalence of clinically significant distress was high. Self-reported depression, sadness, worry and a lack of control over treatment decisions were significantly associated with increasing distress. Emotional problems were the most prevalent problems for people with clinically significant distress. Most people were referred to emotional health services, with depression, fatigue, living regionally and higher socioeconomic status associated with referral.

CONCLUSIONS

Emotional problems such as depression, sadness and worry are associated with increasing levels of distress.

RELEVANCE TO CLINICAL PRACTICE

Not all factors associated with referral to support services were those associated with increasing levels of distress. This suggests that other factors may be more influential to referral decisions.

Moderators of intervention efficacy for Finding My Way: A web-based psychosocial intervention for cancer-related distress

PURPOSE

The present analysis explores whether demographic, psychosocial, or intervention adherence factors moderated treatment efficacy of Finding My Way (FMW), an efficacious self-directed web-based psychosocial program for newly diagnosed curatively treated cancer patients.

METHODS

Participants (n = 191) completed a 6-module intervention (n = 94) or attention-control (n = 97) program. Outcome measures were completed at baseline (T0), post-program (T1), 3-month (T2), and 6-month (T3) follow ups. Age, gender, social support, information processing style (monitoring vs blunting), emotion-regulation difficulties, and intervention adherence were examined as potential moderators.

RESULTS

Age moderated emotional functioning and general distress at T3 with significant intervention benefits only observed in younger participants; age moderated cognitive functioning at T1, with intervention benefits only found in older participants. Gender moderated helplessness/hopelessness, emotional functioning, and cognitive avoidance at T1 with men benefitting more from receiving the intervention vs control. Monitoring information-processing style moderated cancer distress and anxious preoccupation at T3: higher monitors benefitted more from receiving the intervention vs control. Program adherence moderated global QOL, emotional functioning and social functioning at T2 and T3; cognitive avoidance (T1), anxious preoccupation (T2) and role function (T3), with those who completed more of the program benefitting more if they received the intervention than control. Emotion dysregulation and social support each moderated role function at T2, with those more dysregulated and less socially supported benefitting more if they received the intervention than control.

CONCLUSIONS

For select outcomes, FMW is more effective for patients with specific characteristics; these findings can inform future tailoring and targeting of online programs for cancer-distress.

A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy

Background

Art therapy may improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. It remains understudied and underutilized in cancer care. We sought to determine the ability of a pilot art therapy program to improve the physical, mental, and emotional well-being of cancer patients.

Methods

Chemotherapy-recipients, age 18 years and older, diagnosed with any type or stage of cancer, were considered eligible to participate in this single arm, pilot study, using four visual analog scales (VAS) with visually-similar, 0–10 scale (10 being worst) thermometers assessing: 1) pain, 2) emotional distress, 3) depression, and 4) anxiety. Participants were asked to complete all 4 metrics, pre-treatment, post-treatment, and at 48–72 h follow-up, after an hour-long art therapy session. Primary endpoints included post-intervention changes from baseline in the 4 VAS metrics.

Results

Through a reasonable pilot sample (n = 50), 44% had breast cancer, 22% gastrointestinal cancers, 18% hematological malignancies, and 20% had other malignancies. A decrease in all VAS measures was noted immediately post-treatment but remained low only for pain and depression, not for emotional distress and anxiety upon follow up. There was a significant difference between the depression VAS scores of Hispanics (32%) compared to non-Hispanics (56%) (p = 0.009) at baseline. However, compared to non-Hispanics, Hispanics exhibited higher levels of depression after art therapy (P = 0.03) and during the follow-up intervals (p = 0.047).

Conclusion

Art therapy improved the emotional distress, depression, anxiety and pain among all cancer patients, at all time points. While depression scores were higher pre-intervention for Hispanic patients, Hispanic patients were noted to derive a greater improvement in depression scores from art therapy over time, compared to non-Hispanics patients. Discovering simple, effective, therapeutic interventions, to aid in distress relief in cancer patients, is important for ensuring clinical efficacy of treatment and improved quality of life.

Understanding Distress Among Patients With Cancer Receiving Specialized, Supportive Care Services

BACKGROUND

Cancer and its treatment can cause persistent psychosocial consequences for patients. Although distress among the general cancer population has been well studied, many patients who report high distress do not receive specialty, follow-up care. We know little about the distress needs of those who attend appointments with support services. Improved knowledge of this subpopulation of patients with cancer may improve supportive care service delivery.

METHODS

This is a descriptive chart review that examines results from a cancer distress tool in an outpatient supportive care clinic and explores factors associated with distress among patients who attend an appointment for support beyond usual oncologic care. All adult patients with a cancer diagnosis presenting to the supportive care clinic during a 120-day period for an initial intake completed a self-report needs assessment tool. A review of medical records was then conducted. Primarily descriptive statistics, mean comparison, and correlational analysis summarized the data.

RESULTS

Nearly 48% of individuals rated very severe distress in at least one area of functioning. Areas with the highest average distress ratings included pain, fatigue, sleep, and anxiety. No significant associations were found between total distress scores and demographic or illness-related variables. Anxiety and depression were higher among those scheduled to see a behavioral health specialist than a palliative provider.

CONCLUSIONS

Patient and illness factors were not associated with needs among those who attended appointments with support providers. Study results suggest that a biopsychosocial approach from interdisciplinary providers is warranted to manage the needs of patients referred for additional supportive care.

Self-Care Support for Patients with Gastrointestinal Cancer: iCancerHealth

BACKGROUND

Patient-centered symptom assessment and management tools allow patients to perform self-assessments and engage in self-symptom management. Efficacious tools exist for reducing symptom distress; however, little is known about feature-specific use.

OBJECTIVES

This article evaluates the feasibility of the iCancerHealth app as an adjunct to usual patient education regarding cancer symptoms and medication management.

METHODS

We conducted a single-arm, pilot study grounded in the health outcomes model. Our evaluation included (1) enrollment rates, (2) 2-month utilization rates, (3) patient acceptability, and (4) clinician satisfaction with the provider-side application. English-speaking, adult patients receiving care in the gastrointestinal oncology service of a comprehensive cancer center were invited to participate. Research coordinators enrolled consenting participants who had a personal, Internet-connected device; participants registered and used the platform to complete the baseline symptom assessment in clinic. Participants were reminded weekly to use the app and to perform a symptom report 4 to 6 weeks later.

RESULTS

A total of 64 patients were approached, of which 57 (89%; 95% exact confidence interval [CI], 79-96%) enrolled. About half were ≥ 60 years old and 40% were women. Fifty-three patients (93%; 95% exact CI, 85-99%) accessed at least one app feature, at least once, from home. The most frequently used (86%) feature was Health Tracker in which participants monitored and reported symptoms; followed by My Inbox (63%) and My Medications features (60%). The mean acceptability score was 24.8 (standard deviation = 4.2), indicating good acceptability. Clinicians reported that the app was most acceptable with regard to facilitating in-person interactions that occurred after app use.

CONCLUSION

In a sample of adults with various stages of gastrointestinal malignancies, the iCancerHealth app was utilized at a high rate. Features that focused on symptoms and medication side effects plus communication with clinicians were used most frequently. This extends our understanding of preferences and specific feature use with patient-centered technologies.