Benefits of Early Identification of Distress in Patients with an Advanced Cancer Diagnosis Receiving Palliative Radiation

Abstract

Detecting and reducing distress is pivotal in patients with advanced cancer. However, limited data exist on methods of identifying and trending distress in these patients. Additionally, the impact of consultation with a social worker or education regarding end-of-life care on distress is also understudied. In this study, we aimed to analyze if patient reported outcome measures (PROMs) can be used to characterize distress scores and if social work consults can help to reduce distress. We performed a retrospective chart review of 128 patients treated on a palliative radiation oncology service. Patients treated on this service receive PROMs as part of their standard of care and patients rate 13 symptoms including distress, using a Likert 10-point scale. We also assessed whether MOLST education was given at time of consult and whether a social work consult was performed between consult and time of first OTV. We excluded patients who did not receive PROMs at both the time of consultation and first on treatment visit (OTV). The impact of these interventions on distress scores was determined using a comparison of the distress score at time of consultation and the same score at the first OTV. A total of 59 patients were included in this study. Mean age was 65 (Range: 40-86). Primary tumor histologies included lung (27%), breast (10%), prostate (10%) and other (51%). Treated sites included bone (14%), spine (19%), lung (7%) and other (61%). 47% of patients had a social work consultation. 23 patients (39%) reported a distress score > 5 at the time of consultation and 4 patients (7%) reported a distress score of > 10. (Mean: 4; Median: 4; Range: 0-10) Of those patients with distress scores > 5, 30% had lung cancer, 10% had breast cancer, and 10% had prostate cancer. Distress scores were reduced by >=2 points in 17 patients (29%) by the time of their first OTV. 65% of these patients had a social work consultation and 71% had a MOLST discussion at time of consult. This is in comparison to those patients whose scores decreased by <2 points (n=42) where 40% had a social work consult and 71% had a MOLST discussion. PROMS effectively detected increased distress and tracked distress over time. Consultation with a social work at the time of consultation or prior to the first treatment resulted in decrease distress scores in this cohort of patients receiving palliative radiation therapy.