A commentary on 'Effects of screening for psychological distress on patient outcomes in cancer: A systematic review'

Abstract

Meijer et al. [1] set out to “evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identified as distressed; and (2) effects of screening for distress on distress outcomes [1].” While the overall objective is worthy, this seems like an unlikely pairing, as the title of the paper focuses on conducting a systematic review of screening for distress programs. Why then, is the first objective to evaluate interventions for treating distressed patients, independent of any screening program? What should be evaluated are screening programs that: 1) detect distress; 2) refer to treatment, 3) further evaluate the efficacy of treatment programs for those who attend, and 4) assess the efficacy of screening overall by comparing outcomes across the entire screened population. The authors explain this choice by referring to guidelines which recommend that in the absence of studies assessing full screening programs as described above, one should simply look at the efficacy of interventions for patients who likely would have been referred for treatment had screening existed. Hence, in this case that means looking at interventions which included only patients with high distress levels at the outset. While this rationale makes sense once explained, what is lacking in this approach is the linking back to and comparison with the overall population-based statistics of everyone from the distress screening program. It is not an intuitive pairing, especially since there is such a large and independent volume of work evaluating the efficacy of psychosocial interventions in cancer care. The result of this is two very separate reviews, one of treatment studies (which may have nothing to do with screening for distress) and one of screening studies (which may have nothing to do with intervention efficacy). Hence, we will address each part separately as well.