Distress prevalence and associated risk factors within the urothelial cancer population.

Abstract

526 Background: Prevalence of distress has been estimated as high as 40% in some cancer populations, but minimal literature exists regarding distress in bladder cancer patients. Distress has been linked with multiple negative clinical outcomes, with the Commission on Cancer now requiring standardized distress screening for cancer program accreditation. The purpose of this study is to identify prevalence of distress, associated clinical risk factors and psychosocial referral trends in the urothelial cancer population. Methods: This was a retrospective review of distress screening outcomes in bladder cancer patients seen in oncology outpatient clinic at an academic medical center between January 1, 2016-October 1, 2017. Established oncology patients are screened for distress every 30 days using the Patient Health Questionnaire-9 (PHQ-9) and/or the NCCN Distress Thermometer (DT). Questionnaires are completed on an electronic tablet at the time of check-in and linked to the Epic electronic medical record in real time. A data capture program was used to query screening outcomes and identify those who met the threshold scores (PHQ-9 > 8, DT > 4). Results: Of 153 patients with a primary diagnosis of bladder, 81 (53%) completed the PHQ-9 (n = 67) or NCCN distress thermometer (n = 16). The overall incidence of distress was 13.6% with an average score of 12.3 on PHQ-9 (n = 10) and 9 on DT (n = 1). Of the patients with elevated distress, there were 7 males and 4 females with an average age of 64 and 77, respectively. All were either married or widowed. Metastasis was documented in 45%. Five were on an antidepressant and only one had mood disorder previously documented in the history. Social work referral occurred for 73% of the patients. One patient had elevated distress in the 6 months subsequent to diagnosis. Of the seven now deceased patients, all had elevated distress within 6 months of death. Conclusions: At 13.6%, the prevalence of distress in urothelial cancer patients was less than that in general oncology. Metastatic disease and female gender were risk factors while documentation of a psychiatric condition was not. One unexpected finding was that all now deceased patients had endorsed elevated distress within 6 months of death.