Stress Screening and Social Intervention in Radiation Oncology Consultation: A Demonstration of Need

Abstract

<h3>Purpose/Objective(s)</h3> Cancer-related stress is a common and under-treated condition. The NCCN recommends distress screening with the distress thermometer (DT) scale of 0-10 for all cancer patients at all stages of disease in all settings, emphasizing screening at initial visits and after changes in disease status. Distressed patients should be clinically evaluated and referred to social work (SW), mental health professionals, or chaplain care. This study assesses the rate of distress screening and receipt of appropriate SW care at a high-volume academic healthcare network. <h3>Materials/Methods</h3> All patients seen for Radiation Medicine consultation between 7/1/21-12/31/21 were reviewed. Rates of DT documentation, patient distress, and SW intervention (SW referral or consultation) within 14 days were assessed. Chi-square test was used to test if binary variables (curative vs noncurative consult and community vs central tertiary location) were associated with rates of DT screening and SW intervention. Binary logistic regression was used to test the relationship between age and distress. <h3>Results</h3> 2214 patients were seen for radiation oncology consult, and 784 (35%) had DT screening documented. 411 (52%) screened patients were distressed (DT ≥ 4), and 194 (25%) patients were severely distressed (DT ≥ 7). Median age was 67 years. Median distress level was 4 (SD = 3.2, R: 1-6). A total of 306 (14%) patients received SW intervention. Higher rates of SW intervention were present in screened patients vs unscreened patients (30% vs 5%, X²=265.9, p<0.001). Screened patients were more likely to get SW support if they were distressed vs not distressed (48% vs 10%, X²=140, p<0.001). 116 (60%) severely distressed patients received SW intervention. Each additional year of age was associated with a lower rate of reported distress (OR=0.983, p<0.001). Curative, noncurative, and benign consultations composed 58%, 39%, and 3% of the cohort respectively. Rates of distress (52% vs 56%, X²=0.791, p=0.34) and rates of distressed patients receiving SW intervention (51% vs 48%, X²= 0.179, p=0.672) were similar between curative vs noncurative consultations. More patients were seen at community campuses (58%) vs the central tertiary location (42%). Screenings were more frequently documented at community locations vs the central location (40% vs 29%, X²= 28.5, p<0.001). Distressed patients received higher rates of SW intervention at community locations vs the central location (55% vs 36%, X²=14, p<0.001). <h3>Conclusion</h3> Current rates of distress screening at radiation consultation are low. Since 52% of screened patients report distress and unscreened patients are less likely to receive SW support, these results underscore a large unmet need in the care of cancer-related stress. Differences in implementation at the central vs community location indicate unique program initiatives can improve screening and psychosocial support utilization.