Longitudinal assessment of cancer-related distress during cancer treatment using an electronic health record–based tool and impact of social work intervention.

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207 Background: Cancer-related distress affects 35-45% of patients. 2020 ASCO-QOPI standards require baseline and ongoing psychosocial assessments, with interventions as needed. We examined the feasibility and outcomes of integrating the NCCN Distress Thermometer (DT) into the oncology electronic health record (EHR) for distress monitoring. Methods: A flowsheet containing NCCN DT questions was created in Epic EHR (Epic Systems, Verona, WI). Oncology nursing staff administered the electronic DT as part of normal patient ‘rooming’ protocol and alerted providers when distress level was ≥ 4 (DT4). This in turn generated a social work (SW) referral. SW interventions were documented in a SW dashboard. Results: Between May 1 st 2023, and April 30 th 2024, our Epic EHR DT was used to screen 6,270 distinct oncology patients, 1,852 scored >=4. 19.7%, 14.2%, 20.4% and 5.4% of the responses were in the emotional, practical, physical, and familial domains respectively. 447 (24.1%) of these patients were referred to SW. When contacted by SW, worry/anxiety in 37.5%, finance in 34.9% and transportation in 29.4% were the top three concerns. Access to grants, free-care, lodging and gas cards was made available to 37.4%, 14.5%, 20.5% and 13.1% of patients respectively. Additionally, in accordance with QOPI certification requirements, 947 patients with active oncology treatment plans were serially screened during successive cycles of chemotherapy generating 6,330 responses. 398 (42%) of these responses indicated DT4. SW referral was placed in 163 (41%) of patients with DT4. Serial distress monitoring revealed a trend towards improved distress in later cycles of chemotherapy, with DT4 percentage decreasing from 27.7% in cycle 1 to 7.9% in cycle 6. Process improvement efforts informed by this data increased DT use from 42.7% to 50% between May-October 2023 and November 2023-April 2024. Conclusions: Electronic capture of cancer related distress as part of routine care is feasible in a community-based oncology program and resulted in a variety of meaningful SW interventions. Cumulatively, distress caused by emotional, social, and practical problems are more frequent than distress caused by physical problems, underscoring the need for comprehensive cancer care. Distress tends to diminish during successive cycles of chemotherapy, possibly due to lower cancer related morbidity due to therapy, or increased patient familiarity with chemotherapy and improved use of supportive care.