Are Psychiatric Comorbidities in the Radiation Oncology Patient Population Under-Recognized by Providers?

Abstract

Under-recognition of psychiatric comorbidities may be directly tied to potential for poorer patient outcomes. However, there is a paucity of data in radiation oncology settings. This study hypothesized that a disparity exists between the perceived prevalence of psychiatric comorbidities in patients receiving radiotherapy and the rate at which radiation oncologists screen patients for anxiety and depression. From April-July 2021 an online survey was conducted of radiation oncologist members of ASTRO with self-identified practice specializations. Randomly selected invitations were electronically sent to providers from diverse practice backgrounds and geographic locations within the United States and Canada and was conducted using an IRB-reviewed, institutionally approved Microsoft Forms platform. The questionnaire consisted of 20 items examining a broad range of factors that involved general practice demographics, patient screening practice patterns, treatment details and preferred options, and availability and referral data for specialist care for possible psychiatric comorbidities. Statistical analysis was performed using Fisher's exact test. For questions with Yes/No responses, exact binomial test was used. A total of 500online invitations were emailed with 55 responses. Of the responders, 3 did not provide consent. Therefore, 52 (10.4%) responses were included in the analysis and are the subject of this report. This response rate is consistent with other published studies of this type. 85% (p<0.001) of respondents identified the need to screen for psychiatric comorbidities in radiation oncology settings. However, 71% (p = 0.003) did not perform formal screening for psychiatric comorbidities, and of those who did screen, there was no uniformity in the screening tool utilized. Likewise, 79% (p<0.001) did not initiate treatment for psychiatric condition(s). Of providers that did initiate treatment, 91% (p = 0.012) felt that psychiatric comorbidities were under-diagnosed in their patient population. No association was made between providers who specialize in CNS malignancies as being more likely to recognize psychiatric comorbidities in their patient population versus those who do not. Importantly, 75% self-reported that they would benefit from additional training to assess psychiatric comorbidities (p<0.001). A need to screen for psychiatric comorbidities in radiation oncology settings was identified despite very little formal screening performed. Responses revealed adequate community resources exist for referral in most instances. However, providers did not routinely refer patients for treatment of psychiatric comorbidities, even when recognized. This survey identified an unmet need for improved education among providers to engage in screening and referral for psychiatric comorbidities, and to develop a care system that supports standardization of screening practices and tools in this patient population.