Screening for Distress and Unmet Needs in Patients with Cancer


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In the past decade, “screening for distress has been positioned as the sixth vital sign in cancer care, in addition to the first five, which are measurements of pulse, respiration, blood pressure, temperature, and pain,” according to a review article in the Journal of Clinical Oncology. Although distress is not a precise clinical term, “it is part of the clinical significance criterion that is a qualifier for several mood disorders, including major depression and adjustment disorder,” the authors wrote.

“One reason for its adoption in cancer care is that the term distress is often more useful for cancer clinicians than psychiatric terms such as anxiety or depression. It is easily understood by the lay person and does not carry the stigma often associated with diagnostic labels and terms such as psychiatric, psychosocial, and emotional problems. It is usually well understood by non–mental-health clinicians, facilitating quick assessment with simple verbal enquiry or patient self-report,” the authors noted.

Effects of Screening Uncertain

Research is inconclusive about how effective screening for distress is in improving recognition and treatment of distress and associated problems, “but screening seems to improve communication between patients and clinicians and may enhance psychosocial referrals. Direct effects on quality of life are uncertain, but screening may help improve discussion of quality-of-life issues,” the authors noted.

Introducing screening programs requires enlisting administrative support, properly training staff, and ongoing support. To ensure continuity of care, it is important that screening is linked with follow-up care and appropriate treatment. It is also important to follow screening triage guidelines and algorithms, but not at the expense of clinical flexibility,” the authors wrote.

“Patient input is also crucial to help evaluate pilot screening programs and protocols from the perspective of the recipient of care. To maximize reach, we also recommend reviewing to what extent the screening program is acceptable to older patients, those who are medically frail, and minority/underserved groups such as people new to a community for whom English may be a second language.” ■

Carlson LE, et al: J Clin Oncol 30:1160-1177, 2012.



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