Changes in psychosocial distress and the number and types of problems reported by patients with cancer when routine screening is integrated within cancer services

Abstract

Abstract Purpose The impact of measuring patient-reported outcomes on longitudinal clinical outcomes is not well understood. This study explored longitudinal changes in distress and problems reported by cancer patients screened and managed in accordance with a clinical pathway for anxiety and depression (ADAPT CP), implemented over 12 months. Methods Patients reported distress using the Distress Thermometer, and indicated reasons for distress using the 39-item Problem List across five domains: practical, social, emotional, spiritual/religious and physical. Repeat screening occurred on average 3-monthly. Results 660 patients from 10 participating services completed 1,256 screening events over 12 months, reporting 8,645 problems. On average, more emotional (27–34%) and physical (19–22%) issues were reported across all quarters than practical (7–9%) and social (8–9%). Reporting of distress and emotional, physical, practical and social problems reduced from initial to follow-up screens. Younger age predicted increased distress and emotional, practical, and social problems. Longer time since diagnosis (> 6 months) predicted decreased distress and physical problems. Worry, fatigue, sleep difficulties, health of family members, and insurance/finances were more persistent problems. Conclusion Routine anxiety/depression screening is recommended within oncology settings to allow patients to indicate new or persistent problems and hospital staff to monitor and assess needs. Emotional concerns are high in oncology patients, suggesting prioritisation of psychosocial care. These problems can persist over time suggesting the challenge to address these in clinical care, or that access to, or implementation of, evidence-based interventions are not yet widespread. Trial registration This study was part of a larger program of work was registered prospectively with the ANZCTR on March 22, 2017. Trial ID ACTRN12617000411347