National Comprehensive Cancer Network Distress Research Articles

Abstract P6-05-34: Depression and Psychological Distress in Breast Cancer Patients

Abstract Introduction: Patients with breast cancer are at increased risk for depression and suicide compared to the general population. Breast cancer is unique among other cancers in that some treatments aim to decrease levels of estrogen, a hormone that is intricately linked to mood regulation. The trauma of diagnosis, invasive treatments, and hormone dysregulation all possibly contribute to poor mental health outcomes. Understanding risk factors associated with depression and distress are important for timely interventions. Methods: We performed a retrospective chart review of breast cancer patients seen at Froedtert & MCW Cancer Center Breast Care Clinic between 2019 and 2020. The present study had two aims. The primary aim was to identify breast cancer patient populations at increased risk of depression and psychological distress. Patient populations were distinguished by tumor pathology, patient demographics, and types of treatment interventions. The secondary aim was to identify demographic and clinical variables associated with changes in self-reported distress and depression. Univariate and multivariate analysis of demographic and clinical variables was performed in relation to Patient Health Questionnaire (PHQ) and The National Comprehensive Cancer Network (NCCN) Distress Thermometer scores. Results: Data from 197 patients was analyzed. Patients with a history of depression scored significantly higher on distress screening (mean= 4.4  3.0, p=0.004) versus patients without psychiatric history (mean 2.8  2.9). Patients under 50 years old reported higher levels of distress than patients over 70 years old (p=0.031, beta= -1.0). Self-reported distress declined significantly with increased time from initial diagnosis (p=0.043; p=0.006 at 2 years). Distress was significantly higher prior to initiation of radiation versus during and immediately following therapy (p=0.028). A history of depression, younger age, passage of time, and temporal relationship to radiation treatment were not associated with significant differences in self-reported depression on multivariate analysis. Distress and depression screening scores were not significantly impacted by surgery or chemotherapy (p=0.5; p=0.11 respectively). Conclusion: Patients with a known history of depression and age less than 50 reported significantly higher levels of distress but not depression associated with diagnosis of breast cancer. Distress exhibited a greater downward trend than depression following initiation of oncologic intervention. The results of this study indicate that breast cancer patients are susceptible to significant fluctuations in psychological distress. In contrast, clinically relevant depression screening scores were less frequent and less subject to deviation. Table 1. Multivariate analysis. Citation Format: Kelly R. Cotchett, Adam H. Kelly, Aniko Szabo, Yee Chung Cheng, Sailaja Kamaraju, Christopher Chitambar, Lyndsey Wallace, Lubna N. Chaudhary, John Burfeind. Depression and Psychological Distress in Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-34.

The relationship of social determinants and distress in newly diagnosed cancer patients

Patients with a new cancer diagnosis can experience distress when diagnosed. There are disparities in treatment of cancer patients based on social determinants, but minimal research exists on the relationship of those social determinants and distress after a new cancer diagnosis. Our goals were to determine the social determinants associated with distress after a new cancer diagnosis and determine the relationship of distress with outcome. Patients with a new cancer diagnosis at one institution from January 2019 to December 2020 were analyzed. Patients were given the National Comprehensive Cancer Network (NCCN) distress thermometer during their first visit. Demographics, tumor characteristics, clinical variables and survival were recorded. Patients were also asked to share specific factors that led to distress, including: (1) financial, (2) transportation, (3) childcare and (4) religious. A total of 916 patients returned distress thermometers. Mean age was 59.1 years. Females comprised 71.3 (653/916) percent of the cohort. On Dunn’s multiple comparison, the following factors were associated with increased distress level: female (p < 0.01), ages 27 to 45 (p < 0.01), uninsured (p < 0.01) and unemployed (p < 0.01). Patients with higher distress scores also experienced worse overall survival (p < 0.05). Females, young patients, uninsured patients and unemployed patients experience more distress after a new cancer diagnosis. Increased distress is independently associated with worse overall survival. Social determinants can be used to predict which patients may require focused interventions to reduce distress after a new cancer diagnosis.

Cancer-Related Distress: Symptom Clusters in Rural Head and Neck Cancer Survivors.

Rural post-treatment head and neck cancer (HNC) survivors experience high rates of cancer-related distress and may experience unique symptom clusters. Oncology nurses can benefit from a better understanding of the symptom clusters that HNC survivors experience. The purpose of this secondary data analysis was to identify symptom clusters of cancer-related distress in rural HNC survivors. Secondary data analysis was conducted with survey data collected from rural HNC survivors (N = 20). Distress symptoms were measured using&nbsp;the&nbsp;National Comprehensive Cancer Network Distress Thermometer and Problem List, amended for a population with HNC. Symptom clusters were defined as two or more co-occurring symptoms and evaluated based on participant-reported severity using exploratory factor analysis. Resultant clusters were assessed for theoretical and clinical appropriateness. Preliminary analysis suggests rural HNC survivors experience eight symptom clusters. As a first step, the results of this study can help nurses to identify symptom clusters in rural HNC survivors.

“You start feeling comfortable, you just start sharing:” A qualitative study of patient distress screening in Black and White patients with endometrial cancer

ObjectivesBlack patients with endometrial cancer are less likely to express distress and receive referrals for support services compared to White patients. We aim to characterize patient perceptions of the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), a common distress screening tool, among Black and White patients with endometrial cancer and determine strategies to improve equity in referral to appropriate support services. MethodsWe conducted semi-structured interviews with 15 Black and 15 White patients with endometrial cancer who reported varying levels of distress on the NCCN DT & PL. Interviews were audio-recorded, transcribed, evaluated through staged content analysis, and salient themes were compared by patient race. ResultsThe NCCN DT & PL was generally considered understandable, however the word “distress” could be alienating to participants who considered their stress to be less “drastic.” Black participants mentioned fewer negative emotions such as worry and sadness in describing distress and spoke more often of a positive outlook. Additionally, Black participants emphasized the importance of relationship-building with clinicians for open communication on the NCCN DT & PL and clinical encounter. Finally, participants were divided on whether they would alter the way they completed the NCCN DT & PL given more information on cut off scores for referrals, but generally expressed a desire for more direct offers of support services. ConclusionsRelationship-building, open communication around emotion, and longitudinal direct offers of support emerged as avenues to reduce inequities in referral to supportive services for patients with endometrial cancer.

Effect of a novel pilot support group on distress and quality of life in breast cancer patients in Nigeria.

To assess the effect of a new breast cancer support group (BCSG) on breast cancer patients' self-reported distress and quality of life. A single arm pre-post trial providing an eight session healthcare provider led BCSG. Primary outcome variables were distress and quality of life assessed using the National Comprehensive Cancer Network Distress Thermometer (DT) and The Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACT-B+4), respectively. Topics in each session addressed a wide range of issues some of which were pre-selected by the patients themselves. Paired sample t-test was used for data analysis on International Business Machine Statistical Package for the Social Sciences 21. The participants (N=18) had a mean age of 51. Most had secondary school level education (54%), were traders (59%) and had stage 3 or 4 disease (67%). A larger proportion (78% or n=14) of the patients lived in rural areas, while 4 (22%) of the patients lived in Ibadan. Out of the 8 sessions, 12 (67%) of the participants attended 1-3 sessions while 6 (33%) attended 4-8 sessions. There were, significant improvements in emotional wellbeing (t=-4.253; p<0.05) and functional wellbeing (t=-2.191; p<0.05) on the FACT-B+4. There was a significant reduction in the DT score (t=2.345; p<0.05) but the number of items on the problem list were not significantly reduced (t=1.191; p>0.05). Majority (75%) of the patients rated the support group activities as satisfactory. These data show that the support group can benefit breast cancer patients in terms of reduced distress levels along with satisfaction and improvement in the functional and emotional wellbeing indices of quality of life.

Distress, Depression, and the Effect of ZIP Code in Pancreaticobiliary Cancer Patients and Their Significant Others.

Distress screening of cancer patients is mandated by the American College of Surgeons Commission on Cancer. Clinical implementation remains limited, particularly in surgical oncology settings in individuals with pancreaticobiliary cancers. This study evaluated differences in mean distress scores based on the National Comprehensive Cancer Network Distress Thermometer & Problem List for patients with pancreaticobiliary cancers, benign pancreatic conditions, and for their significant others (SOs). The distress screening was conducted at the first office visit and postoperatively in a subset of those who had surgery. Distress Thermometer (DT) scores were dichotomized at ≤5 vs >5 and at ≥7 and correlated with Problem List items. The US ZIP Code database was used to correlate income range, percent poverty, and unemployment in the patient's self-identified ZIP code. Regression models were fitted to identify independent predictors of distress. A total of 547 patients and 184 SOs were evaluated. Thirty percent of patients had DT scores >5, with pancreatic adenocarcinoma patients reporting the highest levels of distress. SOs of pancreatic adenocarcinoma patients reported even greater distress than the patients themselves. As the number of pre-existing medical problems increased; so did DT scores. Distress correlated with physical and emotional problems and worry about insurance coverage and transportation. Higher income level predicted higher DT scores, although poverty predicted lower DT scores. Depression was present in 12% of the patients. Distress improved in those undergoing surgery. Distress and depression in pancreaticobiliary cancer patients and SOs are prevalent. The findings of this study have multiple actionable implications and require diagnosis, treatment, and referral to supportive care resources.

Psychometric Properties and Clinical Utility of the Distress Thermometer in Caregivers of Persons With Multiple Sclerosis.

Caregivers of persons with multiple sclerosis (MS) report high levels of distress. The National Comprehensive Cancer Network Distress Thermometer (DT) is used extensively with patients with cancer and their caregivers but has not been tested in nononcology caregivers. The purpose of this study was to examine the psychometric properties and clinical utility of the barometer portion of the DT in caregivers of persons with MS. A secondary analysis was performed of data from a randomized trial comparing the effectiveness of 2 interventions aimed at reducing psychological outcomes associated with caregiving. The DT and the 4-item Patient-Reported Outcomes Measurement Information System Anxiety and Depression scales, which were administered at baseline, were used for all analyses. Construct validity (known groups) and convergent validity (interscale correlations) were evaluated. Receiver operating characteristic curve analysis was used to evaluate clinical diagnostic test evaluation. The DT had good construct validity supported by strong correlations for known-groups analyses and good convergent validity (r = 0.70-0.72). The DT also demonstrated good discrimination for anxiety (area under the curve [AUC] = 0.83) and depression (AUC = 0.80). The optimal screening cut point on the DT was 4 for anxiety and 5 for depression. The barometer portion of the DT demonstrates good psychometric properties and clinical utility in caregivers of persons with MS. This is the first examination of the DT in MS care partners.

Role for a Web-Based Intervention to Alleviate Distress in People With Newly Diagnosed Testicular Cancer: Mixed Methods Study.

Distress is common immediately after diagnosis of testicular cancer. It has historically been difficult to engage people in care models to alleviate distress because of complex factors, including differential coping strategies and influences of social gender norms. Existing support specifically focuses on long-term survivors of testicular cancer, leaving an unmet need for age-appropriate and sex-sensitized support for individuals with distress shortly after diagnosis. We evaluated a web-based intervention, Nuts & Bolts, designed to provide support and alleviate distress after diagnosis of testicular cancer. Using a mixed methods design to evaluate the acceptability, feasibility, and impact of Nuts & Bolts on distress, we randomly assigned participants with recently diagnosed testicular cancer (1:1) access to Nuts & Bolts at the time of consent (early) or alternatively, 1 week later (day 8; delayed). Participants completed serial questionnaires across a 4- to 5-week period to evaluate levels of distress (measured by the National Comprehensive Cancer Network Distress Thermometer [DT]; scored 0-10), anxiety, and depression (Hospital Anxiety and Depression Score [HADS]-Anxiety and HADS-Depression; each scored 0-21). The primary end point was change in distress between consent and day 8. Secondary end points of distress, anxiety, and depression were assessed at defined intervals during follow-up. Optional, semistructured interviews occurring after completion of quantitative assessments were thematically analyzed. Overall, 39 participants were enrolled in this study. The median time from orchidectomy to study consent was 14.8 (range 3-62) days. Moderate or high levels of distress evaluated using DT were reported in 58% (23/39) of participants at consent and reduced to 13% (5/38) after 1 week of observation. Early intervention with Nuts & Bolts did not significantly decrease the mean DT score by day 8 compared with delayed intervention (early: 4.56-2.74 vs delayed: 4.47-2.74; P=.85), who did not yet have access to the website. A higher baseline DT score was significantly predictive of reduction in DT score during this period (P<.001). Median DT, HADS-Anxiety, and HADS-Depression scores reduced between orchidectomy and 3 weeks postoperatively and then remained stable throughout the observation period. Thematic analysis of 16 semistructured interviews revealed 4 key themes, "Nuts & Bolts is a helpful tool," "Maximizing benefits of the website," "Whirlwind of diagnosis and readiness for treatment," and "Primary stressors and worries," as well as multiple subthemes. Distress is common following the diagnosis of testicular cancer; however, it decreases over time. Nuts & Bolts was considered useful, acceptable, and relevant by individuals diagnosed with testicular cancer, with strong support for the intervention rendered by thematic analyses of semistructured interviews. The best time to introduce support, such as Nuts & Bolts, is yet to be determined; however, it may be most beneficial as soon as testicular cancer is strongly suspected or diagnosed.

Experiences of cancer care in COVID-19: A longitudinal qualitative study.

PurposeThis study aimed to explore the cancer care experiences of people living with and beyond cancer during COVID-19 in Ireland.MethodsThe study adopted a longitudinal qualitative design using semi-structured interviews with sixteen participants. Interviews were undertaken on three occasions over six months (January–June 2021). The National Comprehensive Cancer Network Distress Thermometer (NCCN DT), and Connor-Davidson-Resilience Scale (CD-RISC2) were also used as part of the interviews to measure distress and resilience. Thematic analysis of interview data was conducted and participants' self-rating for distress and resilience was analysed using descriptive statistics.ResultsThe findings revealed participants' constant fear of COVID-19 over time and efforts to stay safe by following the ‘rules’. Isolation was a common experience as COVID-19 restrictions resulted in being alone when attending the hospital for treatment and limited support from family and friends. Telephone follow-up was limited in terms of support and patients' opportunity to ask questions. For a minority, COVID-19 restrictions meant they were ‘not missing out’. On average, participants reported moderate to high levels of resilience at all time points. Distress scores were low but trended upwards from T1 to T2.ConclusionsThe findings highlight the need to avoid restrictions on carers accompanying their close relatives to the hospital for treatment. An evaluation of the effects of the rapid introduction of telephone follow-up on patient outcomes is warranted.

Assessment of Psychological Distress Among Indian Adolescents and Young Adults with Solid Cancer Using the National Comprehensive Cancer Network Distress Thermometer

Purpose The incidence of cancer has increased in India with a visible impact on the young population (aged 15–39 years). The present study aims to evaluate psychological distress among Indian adolescents and young adults (AYAs) with solid cancer using the National Comprehensive Cancer Network (NCCN) distress thermometer. Methods The demographic and clinical characteristics of AYAs patients (age 15–39 years) with cancer were recorded. Assessment of psychological distress of patients using the NCCN distress thermometer was performed at three time points over a period of 3 months. Distress thermometer scale and a self-administered questionnaire in English and Hindi languages was handed over to participants at three time points: at treatment commencement (T1), at 1 month, and 3 months (T2 and T3, respectively) into therapy. Results Of the 259 patients, 63% were women and 37% men; the median age was 34 years. In total, 71 (27%) were ≤ 24 years old and 188 (73%) were&gt;24 years old. Bone sarcoma (39%) was common cancer in AYA patients aged ≤ 24 years and breast cancer (21%) in &gt;24 years of age. The distress scores in both the groups were the highest at diagnosis (T1) followed by that measured at 1 (T2) and 3 months (T3) after diagnosis. The distress score in the age ≤ 24 years was the highest (6.7) at T1, followed by those measured at T2 (2.6) and T3 (1.1) and among age&gt;24 years was the highest (6.6) at T1, followed by those measured at T2 (2.6) and T3 (1.2). Among AYA patients&gt;24 years old, worry, nervousness, sadness, transportation, and sleep were the top five identified problems and in ≤ 24 years old, the top identified problems were worry, financial support, sleep, nervousness, and sadness. Conclusion Adolescents and young adults experience some level of distress associated with the cancer diagnosis, effects of the disease, treatment regardless of the stage and various transitions throughout the trajectory of the disease. The distress thermometer is an easy and useful tool for the assessment of psychological distress in AYA cancers. Early identification of distress burden with the distress thermometer leads to effective interventions in patients with cancer which could improve outcomes including survival in AYAs with cancer in India.

Assessing the rate of identification of financial hardship action items and completion of referrals for care (492)

Objectives: Financial navigation services describe processes to screen patients for financial hardship (FH) and link patients to financial assistance and resources at the health system level. However, rates of referral and the best workflow to utilize these tools are unknown. We aimed to evaluate the use of FH screening instruments to guide referrals to financial navigation services (i.e., social worker, financial counselor, psycho-oncology counseling) within a health system. Methods: We conducted a pilot study implementing universal FH screening in academic gynecologic oncology practice. A lay navigator conducted FH screening at the start of treatment using the 11-item COmprehensive Score for financial Toxicity (COST <26), moderate/ severe distress on the National Comprehensive Cancer Network Distress Thermometer (score >4), and a 10-item financial needs (FN) checklist asking whether they had difficulty affording certain items (i.e., medications, paying bills, lodging). We abstracted referral placement and follow-up information addressing financial needs from the medical record. Results: We screened 131 patients. The average age was 60.4 years (range: 19-84), and 30.6% were non-White. Cancer types included ovarian (40.0%), uterine (36.6%), cervical (17.6%), and vulvar/vaginal/ other (7.6%). Most patients had a primary disease (55.7%) and were on first-line (55.0%) systemic therapy. Of 12 (9.2%) patients with both FH and moderate/severe distress, three (25%) patients received a referral. Of 13 (9.9%) patients with FH but no/mild distress, three (23.1%) patients received a referral. Of 27 (20.6%) patients with moderate/ severe distress but no FH, five (18.5%) patients received a referral. Of the 70 patients who screened negative for FH or moderate/severe distress, nine patients (12.9%) had referrals; of them, four responded ‘yes’ on the distress thermometer regarding practical concerns, such as financial/cost issues. Of 36 (27.5%) patients who reported > 1 concern on the FN checklist, 11 (30.6%) received a referral, and a majority (n=31, 86%) had either positive FH or distress screens. Conclusions: Despite the implementation of FH and distress screening, only about one in four patients who screened positive for FH, moderate/severe distress, or both, received referrals within the health system to address these positive screens. Some patients who screened negative for FH or moderate/severe distress still received referrals, suggesting that interaction with lay navigators may improve patient access to financial and supportive care resources beyond what an automated process can detect. The financial needs checklist generated the highest percentage of referrals (27.5%) compared to COST and/or distress thermometer screening. Objectives: Financial navigation services describe processes to screen patients for financial hardship (FH) and link patients to financial assistance and resources at the health system level. However, rates of referral and the best workflow to utilize these tools are unknown. We aimed to evaluate the use of FH screening instruments to guide referrals to financial navigation services (i.e., social worker, financial counselor, psycho-oncology counseling) within a health system. Methods: We conducted a pilot study implementing universal FH screening in academic gynecologic oncology practice. A lay navigator conducted FH screening at the start of treatment using the 11-item COmprehensive Score for financial Toxicity (COST <26), moderate/ severe distress on the National Comprehensive Cancer Network Distress Thermometer (score >4), and a 10-item financial needs (FN) checklist asking whether they had difficulty affording certain items (i.e., medications, paying bills, lodging). We abstracted referral placement and follow-up information addressing financial needs from the medical record. Results: We screened 131 patients. The average age was 60.4 years (range: 19-84), and 30.6% were non-White. Cancer types included ovarian (40.0%), uterine (36.6%), cervical (17.6%), and vulvar/vaginal/ other (7.6%). Most patients had a primary disease (55.7%) and were on first-line (55.0%) systemic therapy. Of 12 (9.2%) patients with both FH and moderate/severe distress, three (25%) patients received a referral. Of 13 (9.9%) patients with FH but no/mild distress, three (23.1%) patients received a referral. Of 27 (20.6%) patients with moderate/ severe distress but no FH, five (18.5%) patients received a referral. Of the 70 patients who screened negative for FH or moderate/severe distress, nine patients (12.9%) had referrals; of them, four responded ‘yes’ on the distress thermometer regarding practical concerns, such as financial/cost issues. Of 36 (27.5%) patients who reported > 1 concern on the FN checklist, 11 (30.6%) received a referral, and a majority (n=31, 86%) had either positive FH or distress screens. Conclusions: Despite the implementation of FH and distress screening, only about one in four patients who screened positive for FH, moderate/severe distress, or both, received referrals within the health system to address these positive screens. Some patients who screened negative for FH or moderate/severe distress still received referrals, suggesting that interaction with lay navigators may improve patient access to financial and supportive care resources beyond what an automated process can detect. The financial needs checklist generated the highest percentage of referrals (27.5%) compared to COST and/or distress thermometer screening.

Socioeconomic disparities in distress and coping in gynecologic oncology patients (568)

Socioeconomic disparities in distress and coping in gynecologic oncology patients (568)

Risk factors associated with distress among postoperative patients in an academic gynecologic oncology practice (482)

<b>Objectives:</b> Distress is higher among gynecologic oncology patients than other cancer types and is correlated with poor clinical outcomes and decreased quality of life. The purpose of this study was to determine risk factors associated with elevated National Comprehensive Cancer Network Distress Thermometer (NCCN DT) results among patients in gynecologic oncology practice. <b>Methods:</b> A retrospective chart review of all visits at a single gynecologic oncology practice between September 2016 and December 2020 was performed. Distress was measured using the NCCN DT, administered at the postoperative visit for every patient undergoing surgery in practice. DT were analyzed as discretized values (DT < 3=low distress, DT 4-8 = moderate distress, or DT, ≥9 = high distress), chosen based on clinic thresholds for distress score intervention. Patients with a score > 4 received a referral to social work, with an urgent referral for a score >9. Univariate and multivariate logistic regression analyses were performed to analyze differences in NCCN DT results by multiple personal, demographic and disease-related variables. Risk factors were determined using the Wald test with Bonferroni correction for univariate analyses. The threshold for statistical significance was set at <i>p</i><0.05. <b>Results:</b> A total of 1798 NCCN Distress Thermometers were collected at postoperative visits and included in the analysis (mean age: 58.31± 13.98 years, mean BMI: 31.66± 9.42). Ovarian (36.51%) and endometrial cancer (31.74%) were the most common cancers. More than half (59.07%) of patients reported a partnered relationship status and had private insurance (56.73%). Benign pathology was known prior to completion of the NCCN DT in 13.07% of patients. Most patients (71.64%) endorsed a low level of distress. A moderate level of distress was reported by 26.53% of patients, whereas a minority of patients (1.84%) documented a high distress level. Increasing levels of distress were significantly associated with a history of depression (p=.001), tobacco use (p=.007), and vaginal cancer (p=.008). Knowledge of benign pathology prior to completion of NCCN DT (p=.023) was associated with low levels of distress. <b>Conclusions:</b> More than a quarter of women undergoing surgery in a gynecologic oncology practice reported moderate or high distress at their postoperative visit. Understanding of risk factors provides opportunities to identify patients most at risk for experiencing high distress. Patients with known benign pathology demonstrated decreased distress, indicating that surgical intervention alone does not significantly impact levels of distress. Association between unmodifiable risk factors and distress, such as vaginal cancer, provides an opportunity for targeted intervention early in the treatment course, while the association with modifiable risk factors (tobacco use, depression) provides insight into counseling and prevention strategies.

Comparing financial hardship (FH) assessment tools among gynecologic cancer patients (491)

<b>Objectives:</b> Up to 50% of gynecologic oncology patients experience financial hardship (FH). Several FH screening tools are available; however, it is unclear which tool is optimal. We aimed to compare four FH screening tools. <b>Methods:</b> We conducted a pilot study implementing universal FH screening in an academic gynecologic oncology practice among patients starting a new line of therapy. The four screening tools included: the 11-item COmprehensive Score for financial Toxicity (COST) tool, the National Comprehensive Cancer Network Distress Thermometer, a 10-item financial needs (FN) checklist of difficulty affording care-related needs (utilities, transportation/lodging for treatments, upfront payments, insurance, medications, medical supplies, child/elder care, employment, basic needs), and a single-item question ("Do you have difficulty affording medications?"). <b>Results:</b> Of 137 patients starting a new therapy from February to August 2021, 131 (96%) underwent screening. The average age was 60.4 years (range: 19-84), and 30.6% were non-White. Cancer types included ovarian (40.0%), uterine (36.6%), cervical (17.6%), and vulvar/vaginal/other (7.6%). Most patients had a primary disease (55.7%) and were on first-line (55.0%) systemic therapy. Twenty-six (19.8%) patients had a COST score <26 indicating FH, and 42 (30.7%) had a distress score ≥4 indicating moderate/higher distress. On the FN checklist, 37 (28.2%) patients had difficulty affording > 1 item, including affording insurance/medical bills (payments due after the service) (<i>n</i>=18), upfront payments (due at the time of service) (<i>n</i>=12), and utilities (<i>n</i>=11). More patients with COST<26 had difficulty affording > 1 FN checklist item compared to those with COST >26 (73.1% vs 14.4%), whereas patients with distress > 4 and distress <4 had a similar frequency of difficulty affording > 1 FN checklist item (31.0% vs 25.8%). All patients responded no to the single-item question, "Do you have difficulty affording medications?" although four patients reported difficulty affording medications on the FN checklist. Thirteen (9.9%) patients reported specific practical/financial concerns on the distress thermometer; 46.2% (<i>n</i>=6) of these patients had a COST <26, and 76.9% (<i>n</i>=10) had > 1 FN checklist item. <b>Conclusions:</b> Universal screening for FH is feasible in patients starting treatment. A specific FH multi-item screening tool may be needed; however, a single item about affording medications may not be useful.

A systematic review of the translation and validation methods used for the national comprehensive cancer network distress thermometer in non-English speaking countries.

The National Comprehensive Cancer Network (NCCN) distress thermometer (DT) was developed as a brief screening tool for detecting distress in cancer patients. Conceptually, distress was considered a more acceptable and inclusive term than other psychological terms such as depression or anxiety. It is used extensively in the United States and other English-speaking countries. We aim to describe the translation and validation methods of the DT and describe the recommended cutoff scores used to identify cancer patients experiencing clinically significant distress. Nine bibliographic databases were searched using keywords to identify original research studies for non-English speaking countries' cancer patients. Full articles were independently assessed for inclusion and data extraction by two authors. The review of 4442 articles yielded 39 articles that validated the DT. We identified 20 languages in 25 countries. In all but one country, investigators were able to agree upon a word or phrase that meant distress in their native language that was subsequently validated against standardized instruments. Asian, Middle Eastern and European counties recommended cutoff score of 4 or 5 to identify clinically significant distress; however, European Union countries had a range of 2to 7. Use of the translated DT with non-English speaking cancer patients provides a simple and quick tool to identify high distress. Similar to NCCN, the cutoff score of 4 or 5 was suggested by 78% of the studies; however, more studies of different types of cancer and within and among more countries will strengthen a recommended global DT cutoff score.

PS04 (P64): The national comprehensive cancer network distress thermometer as a screening tool for psychological and social distress in patients with keratinocyte skin cancer

PS04 (P64): The national comprehensive cancer network distress thermometer as a screening tool for psychological and social distress in patients with keratinocyte skin cancer

P64: The National Comprehensive Cancer Network distress thermometer as a screening tool for psychological and social distress in patients with keratinocyte skin cancer

P64: The National Comprehensive Cancer Network distress thermometer as a screening tool for psychological and social distress in patients with keratinocyte skin cancer

Prevalence and predictors of psychological distress among patients with thyroid cancer during transitional period in China: a cross-sectional study.

This study aimed to explore the psychological distress and its predictors among Chinese patients with thyroid cancer during their transitional period from hospital to home. A cross-sectional study was conducted in a cancer hospital in Tianjin, China. A total of three hundred patients with thyroid cancer completed the Chinese version of the National Comprehensive Cancer Network Distress Thermometer (DT), Cancer Fatigue Scale, and the Brief Illness Perception Questionnaire. Logistic regression was used to obtain the model of predictors of psychological distress among patients with thyroid cancer during the transitional period. The DT score of 300 patients with thyroid cancer ranged from 0 to 10, and the median DT score was 2 [1-4]. The prevalence of clinically relevant psychological distress (DT score ≥ 4) in Chinese patients with thyroid cancer during their transitional period was 29.33% (88/300). The results of logistic regression analysis showed that gender (OR = 2.505, P = 0.036), fatigue (OR = 1.086, P = 0.005), and illness perception (OR = 1.137,P < 0.001) were significantly related to psychological distress in patients with thyroid cancer. The psychological distress of patients with thyroid cancer during the transitional period is medium level. Patients with thyroid cancer who are female, easily fatigued, and have worse illness perceptions are more likely to experience psychological distress. Therefore, clinical attention should be paid to female patients and potential interventions aimed at improving fatigue and illness perception. It may reduce the prevalence of psychological distress during the transitional period.

Analysis of the likelihood of depression versus distress screening to identify need for intervention.

1544 Background: Psychosocial assessments are increasingly used to evaluate a patient-centered approach to quality cancer care delivery. Value-based oncology programs endorse screening metrics at every encounter. To comply with expectations of these programs, our cancer center utilizes two standardized tools: Patient Health Questionnaire (PHQ) to screen for depression at every encounter; National Comprehensive Cancer Network Distress Thermometer (NCCNDT) to screen for acute distress at clinically meaningful intervals. In 2021, oncology patients completed, on average, 5 annual appointments at Sidney Kimmel Cancer Center (SKCC), with a median appointment frequency of once every 19 days. Given the high encounter-per-patient ratio, we aimed to assess utility of frequent screening leading to supportive intervention. Methods: A retrospective analysis was conducted of medical oncology patients seeking care at SKCC with a completed depression and/or distress screening, as recorded in the patient’s electronic health record, between 1/1/2021 and 12/31/2021. This analysis intended to evaluate the percentage of patients whose scores indicate need for intervention. Patients who received more than one screening were attributed the highest score recorded during the measurement period. Results: A total 13,342 patients were screened at least once for either depression (n = 7,433), distress (n = 1,325), or both (n = 4,584). 3% of all patients screened ever met the intervention threshold (IT) for depression; 33% met the IT for distress. Of the patients who received both types of screenings, 31% met the IT for distress without meeting the threshold for depression. Those 1,418 patients would not have been referred for intervention through depression screening alone. Conclusions: This analysis highlights routine depression screening among a cancer population with a high encounter-per-patient ratio may not be sensitive in identifying need for supportive intervention. It also suggests that distress screening is more likely to lead to a supportive intervention than depression screening alone. This analysis combined with the anecdotal assessment by social workers supports the value of distress at clinically meaningful intervals over depression screening at each encounter. [Table: see text]

Electronic capture of cancer-related distress in a community oncology program.

1577 Background: Cancer related distress can be seen in as many as one in two patients. Many organizations such as the Commission on Cancer require distress screening. National Comprehensive Cancer Network (NCCN) distress thermometer is a common tool used for screening. We studied feasibility of embedding the NCCN thermometer into oncology electronic health record (EHR) for routine patient care. We concurrently studied feasibility of using a mobile health tool for serial evaluation of cancer related distress. Methods: A flowsheet containing NCCN distress thermometer questions was created in Epic EHR (Epic Systems, Verona, WI). Oncology nurses used the flowsheet for routine patient assessment. Patients with distress level ≥ 4 answered additional questions. Ancillary care providers such as palliative care nurses or social workers addressed the identified needs by providing appropriate ‘services’. A field to capture these interventions was created. We also adapted our previously reported web based mobile tool [1] for monitoring cancer distress. Patients rated their distress on a 1-10 scale and highlighted the distress domain (physical, emotional, practical, family). Distress level ≥ 4 generated a color-coded flag for provider review and intervention. Data from both electronic tools was periodically analyzed to inform patient care and quality improvement. Results: Between January and December 2021, Epic EHR based distress flowsheet collected 28,594 distinct responses in 911 patients. 57.4%, 14.9%, 14.1%, 9.4% and 2.3% of the responses were in the physical, emotional, practical, familial and spiritual domains respectively. ‘Other’ responses were 1.4%. Cumulative frequency of non-physical problems was 42.5%. 1819 ‘services’ were provided with 357 emotional, 351 work, 351 housing, 350 transportation and 350 financial need-based interventions. Of 1231 patients who used the distress scale and provided additional comments, 315 (25.5%) had distress levels ≥ 4. The mobile tool captured 849 unique patient responses to the distress question between April 2020 and February 2022. Distress level ≥ 4 was flagged by 281 unique patients (33.09%). Average distress level was 2.7. Emotional domain problems generated the greatest distress level followed by family, physical and practical problems in decreasing order. Conclusions: We demonstrate feasibility of electronic capture of cancer related distress to facilitate holistic patient care in a community-based oncology program. EHR based and mobile tool distress evaluations generated concordant results. Distress caused by emotional, practical and familial domain problems was nearly as frequent and often more severe than distress caused by physical problems, underscoring the need for comprehensive cancer care.