Incorporating routine mental health assessment into survivorship.

Abstract

350 Background: Cancer survivors experience higher rates of mental health (MH) symptoms including anxiety and depression compared to the general population. To address this in our longitudinal survivorship clinic, the Patient-Reported Outcome Measurement Information System (PROMIS) Global health measure is routinely administered and reviewed at point-of-care with psychosocial status incorporated in survivorship care (SC) plans. The uncertainly and social isolation that occurred during the COVID-19 pandemic increased the risk of adverse MH outcomes. This study examines PROMIS Global MH subscale scores and discussions of MH prior to, during and following the pandemic. Methods: Patients who had at least one SC visit and a completed PROMIS-Global measure within 22 months prior to and after the Massachusetts COVID-19 state of emergency (SoE) (March 20, 2020-June 15, 2021) were evaluated. MH subscale scores were calculated using scoring algorithms. A paired t-test was used to compare scores from each time period. Patient characteristics were summarized from the clinic’s database. Clinician notes were analyzed to determine if MH discussions occurred. Results: All 41 patients had been diagnosed during childhood, adolescence, or young adulthood (median age of 12 years, range 0-36), with a median current age of 31 years (range 19-54). 61% were diagnosed with leukemia or lymphoma, 66% were female, 80% were White. Patients had been in the clinic from 0-7 years, with 15% of the initial visits occurring within the pre-SOE period. At time of entry into clinic 73% had a known late effect, 32% had a comorbidity and 29% had a known MH disorder. At some point in their SC, 41% of patients had been encouraged to pursue MH care. During the SoE, those with MH concerns were triaged for outreach; 78% of patients received virtual and/or in-person visits; PROMIS was not collected during virtual visits. Mean PROMIS-Global MH subscale scores were not statistically different by time period: 49.9 mean (9.3SD) pre vs 48.3 mean (10.1SD) post SoE (p=0.10) and did not differ from population norms. MH discussions occurred prior to (54%), during (53%) and following (49%) the SoE. Conclusions: Despite the additional barriers to providing care brought on by the pandemic, the MH tools in place supported quick identification of patients at risk and ongoing MH discussions. Consistent inclusion of MH assessment into SC should be encouraged as part of ongoing quality care, not only in response to the pandemic.