Psycho-oncology Services Research Articles

Multidisciplinary care in the hematology clinic: Implementation of geriatric oncology.

Multidisciplinary care is believed to provide benefits to patients with cancer. Tumor board conferences as well aspalliative care or psycho-oncological services have not only become common in oncology, but also in hematology clinics dedicated to the treatment of hematological cancers. Malignant hematological diseases are highly prevalent among older persons. Demographic changes in many countries worldwide are prompting the integration of geriatric principles, methodology, and expertise into existing procedures and infrastructure of multidisciplinary care in hematology clinics. Achieving this goal requires the close collaboration or even incorporation of multiple new professions in the hematology clinic in order to meet the needs of older patients with hematological malignancies who also have comorbidities and functional impairments. We here review the rationale, current evidence, and practical approaches of integrating geriatric oncology into multidisciplinary care in the hematology clinic.

Psychosocial distress and desire for support among skin cancer patients - impact of treatment setting.

Diagnosis and treatment of malignancies are frequently associated with a variety of problems for affected individuals and their relatives. In order to ensure adequate psycho-oncological and social care, it is recommended to routinely assess patients' psychosocial distress. While psychosocial services for inpatients have been expanded in recent years, the outpatient care structure in terms of psycho-oncological support is far from satisfactory, especially in Mecklenburg-Western Pomerania. We therefore set out to investigate the following questions: Does the need for psychosocial care vary in relation to (a) the treatment setting (inpatients vs. outpatients) and (b) the diagnosis? (c) Do patients experiencing psychological distress desire support? We asked both inpatients and outpatients to rate their psychosocial situation using the Hornheide Questionnaire. Patients were also asked about their desire for psychological support and the preferred contact person. (a) The treatment setting had no impact on the need for psychosocial care and the desire for support. (b) Depending on the type of skin cancer, there were significant differences in the need for such care among the 251 patients surveyed. (c) Despite a certain discrepancy, there was a significant correlation between psychosocial distress (39.0%; n = 98/251) and desire for support(14.3%; n = 35/245). (d) Patients experiencing distress primarily chose physicians (n = 21) and psychologists (n = 20) as potential contact persons. (1) In addition to the level of distress, the desire for support should be inquired. (2)Recommendations by physicians represent an important means of access to psycho-oncological services. (3) Services for outpatient support should be expanded.

Patient related factors influencing the utilization of the psycho-oncology service

Patient related factors influencing the utilization of the psycho-oncology service

Focusing on cancer patients' intentions to use psychooncological support: A longitudinal, mixed-methods study.

ObjectiveDistress screening programs aim to ensure appropriate psychooncological support for cancer patients, but many eligible patients do not use these services. To improve distress management, we need to better understand patients' supportive care needs. In this paper, we report the first key finding from a longitudinal study that focused on patients' intentions to use psychooncological support and its association with distress and uptake of the psychooncology service.MethodsWe conducted a prospective, observational study in an Oncology Outpatient Clinic and assessed distress, intention to use psychooncological support, and uptake of the psychooncology service by using the Distress Thermometer, a semistructured interview, and hospital records. We analyzed data with a mixed‐methods approach.ResultsOf 333 patients (mean age 61 years; 55% male; 54% Distress Thermometer ≥ 5), 25% intended to use the psychooncology service (yes), 33% were ambivalent (maybe), and 42% reported no intention (no). Overall, 23% had attended the psychooncology service 4 months later. Ambivalent patients reported higher distress than patients with no intention (odds ratio = 1.18, 95% confidence interval [1.06‐1.32]) but showed significantly lower uptake behavior than patients with an intention (odds ratio = 14.04, 95% confidence interval [6.74‐29.24]). Qualitative analyses revealed that ambivalent patients (maybe) emphasized fears and uncertainties, while patients with clear intentions (yes/no) emphasized knowledge, attitudes, and coping concepts.ConclusionsWe identified a vulnerable group of ambivalent patients with high distress levels and low uptake behavior. To optimize distress screening programs, we suggest addressing and discussing patients' supportive care needs in routine clinical practice.

Parental cancer: Characteristics of users of child-centred counselling versus individual psycho-oncological treatment.

The aims of this study were to investigate the characteristics of users of a specific child-centred counselling service (COSIP) and to compare those to parents using an individual psycho-oncological treatment (PO). We conducted a retrospective analysis on data of users of COSIP and users of PO. Database was the routine assessment (demographic and disease-related characteristics, GAD-7, PHQ-9, EORTC QLQ-C30, and current concerns) of an outpatient psycho-oncological clinic with additional child-centred counselling. A total of 151 patients and 49 partners with children ≤21years were included. We conducted descriptive analyses and group comparisons. Fifty-nine patients and partners used COSIP only or additionally to individual psycho-oncological service. PO users were more depressed and were more anxious than COSIP users. Patients using PO reported worse emotional functioning than patients using COSIP. Partners using PO reported worse global quality of life and more symptoms of fatigue than partners using COSIP. With regard to current concerns, patients using COSIP reported child-related issues more frequently than PO users. PO users reported symptoms of anxiety, depressive symptoms, or exhaustion more frequently than COSIP users. The findings demonstrate that patients and partners self-referring to PO or COSIP are highly burdened. COSIP users experience different psychosocial burden than PO users. As poor mental state of parents is a risk factor for the development of mental problems in children, parents using only PO may benefit from additional child-centred support. Accordingly, the need for COSIP should be assessed continuously during PO of patients with children ≤21years.

Quality of Life Among Children with Cancer in Gaza Strip

The study aimed to assess quality of life among children with cancer in Gaza Strip and the factors influencing their life conditions. A descriptive, analytic, cross-sectional study include 122 children with cancer whose age was between 7 to 18 years. Data collected at El Ranteesy Specialized Pediatric Hospital and European Gaza Hospital data collected by using the Pediatric Quality of Life Inventory (PedsQL 4.0 generic core scale). Participants were interviewed by the researcher and completed the questionnaire which focused on quality of life included five domains. The result showed that most of the participants have a medium level of quality of life with the mean score was 52.53%. The social function domain got the highest score with equaled (60.98%), physical function domain (52.94%), the school function domain (48.85%), and the lowest domain was emotional function domain with equaled (47.13%). Finding showed that gender, age, hospital, participants’ residence, participants’ father level of education, participants’ mother level of education, diagnosis years for the current disease, and family history of cancer not statically significant difference in the quality of life. Providing psycho-oncology services in ministry of health together with medical treatment, anxiety reduction measurement, provide program that can enhance the level of quality of life, and psychosocial support schedule for children and their families. Finally, guiding the society of how children with cancer treated through improve the awareness and educational campaign and encourage the skills of communication for healthcare givers.

Relationship between physicians' perceived stigma toward depression and physician referral to psycho‐oncology services on an oncology/hematology ward

This study was performed to identify relationships between physicians' perceived stigma toward depression and psycho-oncology service utilization on an oncology/hematology ward. The study participants were 235 patients in an oncology/hematology ward and 14 physicians undergoing an internal medicine residency training program in Inha University Hospital (Incheon, South Korea). Patients completed the Patient Health Questionnaire-9 (PHQ-9), and residents completed the Perceived Devaluation-Discrimination scale that evaluates perceived stigma toward depression. A total PHQ-9 score of ≥5 was defined as clinically significant depression. Physicians decided on referral on the basis of their opinions and those of their patients. The correlates of physicians' recommendation for referral to psycho-oncology services and real referrals psycho-oncology services were examined. Of the 235 patients, 143 had PHQ-9 determined depression, and of these 143 patients, 61 received psycho-oncology services. Physicians recommended that 87 patients consult psycho-oncology services. Multivariate analyses showed that lower physicians' perceived stigma regarding depression was significantly associated with physicians' recommendation for referral, and that real referral to psycho-oncology services was significantly associated with presence of a hematologic malignancy and lower physicians' perceived stigma toward depression. Physicians' perceived stigma toward depression was found to be associated with real referral to psycho-oncology services and with physician recommendation for referral to psycho-oncology services. Further investigations will be needed to examine how to reduce physicians' perceived stigma toward depression.

Depression and its impact on health-related quality of life among Chinese inpatients with lung cancer.

Depression is of great concern for patients with cancer. A detailed epidemiological profile of depression in Chinese patients with lung cancer and whether depression impacts patients’ health-related quality of life (HRQOL) remain unknown. This study examined the prevalence and socio-demographic and clinical correlates of depression and its effect on HRQOL in Chinese inpatients with lung cancer of two large general hospitals. A total of 148 inpatients were consecutively recruited, and administered with a standardized questionnaire to collect socio-demographic and clinical data. Depression and HRQOL were assessed with the Hospital Anxiety and Depression Scale and World Health Organization QOL Scale Brief Version, respectively. As high as 43.2% Chinese inpatients with lung cancer had clinically significant depressive symptoms. Multiple logistic regression found that depression was significantly associated with moderate-to-severe pain (OR: 4.43), metastatic cancer (OR: 3.63), a short duration after cancer diagnosis (OR: 1.04), poor performance status (OR: 3.41), and small-cell cancer (OR: 4.52). Depressed patients had significantly poorer HRQOL than not depressed patients in terms of all four domains of HRQOL. After controlling for the potential confounding effects of socio-demographic and clinical factors with analysis of covariance, these group-differences in physical (F = 29.074, P < 0.001), psychological (F = 76.869, P < 0.001), social (F = 21.465, P < 0.001), and environmental (F = 27.685, P < 0.001) HRQOL remained statistically significant. Depression is prevalent in inpatients with lung cancer and independently associated with poor HRQOL. To address this serious issue, effective pain management, psycho-oncology services and, when necessary, psychiatric assessment and treatment, should be routinely provided in oncology departments of Chinese general hospitals.

Psychoonkologische Versorgung in Stadt und Land

Background. The diagnosis of cancer is frequently accompanied by significant psychosocial distress not only for patients but also for their caregivers. Psycho-oncological services are nowadays implemented in routine oncological care to address such needs; however, little is known about utilization of psychosocial support by patients and caregivers outside of cancer centers. Objective. The aim of the study was to establish whether there is sufficient coverage and adequate use of psycho-oncological services in cancer survivors living in rural areas. Additionally, we were interested in the number of caregivers who received any form of psycho-oncological care. Methods. In a cross-sectional survey we estimated psychosocial stress and use of psycho-oncological services in mainly rural cancer patients, which we recruited in primary care practices. We used the distress thermometer (DT) and the short form of the Patient Health Questionnaire (PHQ-4) as well as a checklist on utilization of psychosocial and other support facilities. A total of 585 cancer patients and 488 caregivers provided data. Results. Approximately 2 years after diagnosis 48% of the patients experienced increased levels of distress and approximately 25% expressed signs of depression and/or anxiety disorders. Caregivers showed comparable levels of psychological burden. Large differences 22% versus 6%) were found between patients and caregivers with respect to utilization of psycho-oncological resources. Conclusion. Financial and work-related support was provided in more than half of the patients; however, the level of emotional support was poor, in particular with respect to caregivers needs. Public awareness on available resources should be strengthened.

Understanding why cancer patients accept or turn down psycho-oncological support: a prospective observational study including patients\u2019 and clinicians\u2019 perspectives on communication about distress

BackgroundInternational standards prioritize introducing routine emotional distress screening in cancer care to accurately identify patients who most need psycho-oncological treatment, and ensure that patients can access appropriate supportive care. However, only a moderate proportion of distressed patients accepts referrals to or uses psycho-oncological support services. Predictors and barriers to psycho-oncological support service utilization are under-studied. We know little about how patients and oncologists perceive the discussions when oncologists assess psychosocial distress with a screening instrument.We aim to 1) assess the barriers and predictors of uptake of in-house psycho-oncological support along the distress screening pathway in cancer patients treated at a University Oncology Outpatient Clinic and, 2) determine how patients and clinicians perceive communication about psychosocial distress after screening with the Distress Thermometer.MethodsThis is a quantitative prospective observational study with qualitative aspects. We will examine medical and demographic variables, cancer patient self-reports of various psychological measures, and aspects of the patient-clinician communication as variables that potentially predict uptake of psycho-oncological support service. We will also assess the patients’ reasons for accepting or refusing psycho-oncological support services. We assess at three points in time, based on paper-and-pencil questionnaires and two patient interviews during the study period. We will monitor outcomes (psycho-oncology service uptake) four months after study entry.DiscussionThe study will improve our understanding of characteristics of patients who accept or refuse psycho-oncological support, and help us understand how patients’ and oncologists perceive communication about psychosocial distress, and referral to a psycho-oncologist. We believe this is the first study to focus on factors that affect uptake or rejection of psycho-oncological support services along the screening and referral pathway. The study 1) combines standard assessment with qualitative data collection, 2) embraces patient and oncologist perspectives, and, 3) focuses on patient-clinician communication about psychosocial issues raised by a standard screening instrument.Our results may improve routine practices and eliminate barriers to adequate health care, and make it easier to recognize patients with high distress levels who underuse the service.

Metacognitive Therapy for Emotional Distress in Adult Cancer Survivors: A Case Series

Many adult cancer survivors experience persistent emotional distress after completing cancer treatment. The aim of this study was to test the potential of a brief transdiagnostic psychological intervention—metacognitive therapy (MCT)—in reducing emotional distress in adult cancer survivors. A non-concurrent multiple baseline design with 3- and 6-months follow-up was used to evaluate the effects of MCT in four patients consecutively referred to a psycho-oncology service. Each patient received six 1-h sessions of MCT. Anxiety, depression, worry/rumination, fear of cancer recurrence and metacognitive beliefs were assessed using self-report questionnaires. MCT was associated with clinically significant reductions in anxiety, depression, fear of cancer recurrence, worry/rumination and metacognitive beliefs at the end of treatment, and gains were maintained in all patients to 3-months follow-up and in three out of four patients to 6-months follow-up. MCT is a promising brief transdiagnostic approach to psychological morbidity in adult survivors of cancer. Larger scale controlled trials are now required.

Introduction of the distress thermometer on an oncological ward

Background: Patients suffering from oncological diseases experience physical, mental, social, and spiritual distress. 20 to 40 % show increased stress and need professional support. Therefore, we implemented the distress thermometer (DT) as a screening instrument on an inpatient oncological ward. Method: We chose an action research approach („look“-„think“-„act“-cycle) for this practice development project. Firstly, we examined the current assessment of psychosocial distress and conducted a literature research („look“). On this basis we elaborated an instruction for the DT („think“) and implemented the instrument („act“). We evaluated the project by analyzing the completed DT questionnaires and by conducting a survey of patients and nurses („look“). Results: After implementing the DT, mentions of psychosocial distress in patient records increased by 40 %. Before the implementation, distress was documented in only 39.5 % of patient records and 4.5 % of all patients were referred to the psycho-oncology service. After introducing the DT, psychosocial stress was mentioned in 86 % of patient records and 7.3 % of patients received psycho-oncological counselling. 49.6 % of patients were screened. Nurses considered the screening tool as useful and supportive. Conclusions: By means of the DT, a systematic screening of psychosocial distress is feasible. The instrument can be easily implemented and applied in daily practice.

The use of psychosocial support services among Japanese breast cancer survivors.

This study aimed to investigate the use of psychosocial support services, the intention to use these services, and to elucidate the characteristics of survivors most likely to use support services among Japanese breast cancer survivors. We invited breast cancer survivors to complete an online questionnaire via an email sent to subscribers of a non-profit organization mailing list. We asked participants questions related to demographics, opinions on the state of psychosocial support services, and their interest in using these services. Participants were also asked to complete the Hospital Anxiety and Depression Scale and the Brief Cancer Worry Inventory (BCWI). We analyzed the data of 171 participants. Those who used some form of psychosocial support service constituted 50.9% of the participant population. Participants used cancer consulting and support center services (13.5%), hospital and non-hospital support groups (12.9%, respectively), psychiatry (11.1%), hospital and non-hospital cancer salons (8.8%, respectively), psychosomatic medicine (8.2%), therapist counseling (6.4%) and psycho-oncology department services (4.1%). Non-users who suffered from adjustment disorders or major depression (52.1%) reported higher total BCWI and the subscale scores had no concrete plans to use psychosocial support services. The usage levels of psychiatry, psychosomatic medicine and psycho-oncology services in our study were higher than those reported in any previous Japanese study within the psycho-oncology field. Participants joining a breast cancer survivors' mailing list, or their being female, may have led to a higher use of such services. A high degree of distress does not necessarily lead cancer survivors to seek psychosocial support services.

Accessibility, Availability, and Potential Benefits of Psycho-Oncology Services: The Perspective of Community-Based Physicians Providing Cancer Survivorship Care.

As persons of trust, community-based physicians providing survivorship care (e.g., general practitioners [GPs]) often serve as the primary contacts for cancer survivors disclosing distress. From the perspective of physicians providing survivorship care for cancer patients, this study explores (a) the accessibility, availability, and potential benefits of psycho-oncology services; (b) whether physicians themselves provide psychosocial support; and (c) predictors for impeded referrals of survivors to services. In a cross-sectional survey, all GPs and community-based specialists in a defined region were interviewed. In addition to descriptive analyses, categorical data were investigated by applying chi-square tests. Predictors for impeded referrals were explored through logistic regression. Of 683 responding physicians, the vast majority stated that survivors benefit from psycho-oncology services (96.8%), but the physicians also articulated that insufficient coverage of psycho-oncology services (90.9%) was often accompanied by impeded referrals (77.7%). A substantial proportion (14.9%) of physicians did not offer any psychosocial support. The odds of physicians in rural areas reporting impeded referrals were 1.91 times greater than the odds of physicians in large urban areas making a similar report (95% confidence interval [1.07, 3.40]). Most community-based physicians providing survivorship care regard psycho-oncology services as highly beneficial. However, a large number of physicians report tremendous difficulty referring patients. Focusing on those physicians not providing any psychosocial support, health policy approaches should specifically (a) raise awareness of the role of physicians as persons of trust for survivors, (b) highlight the effectiveness of psycho-oncology services, and (c) encourage a proactive attitude toward the assessment of unmet needs and the initiation of comprehensive care. Community-based physicians providing survivorship care for cancer patients regard psycho-oncology services as a highly reasonable and beneficial addition to medical care. In light of insufficient local coverage with services, difficulties with seamless referrals constitute a major challenge for physicians. Apart from emphasizing the effectiveness of psycho-oncology services and proactive attitudes toward the assessment of unmet needs, future policies should focus on the integration of medical and psychosocial follow-up of cancer survivors, especially in rural areas.

The next challenge for psycho-oncology in the UK: targeting service quality and outcomes.

The acceptance and provision of psychosocial cancer care in the UK is moving forward positively, aided by patient advocacy and psychologically minded healthcare policies. The unfolding challenge now is of targeting the quality and outcomes of clinical psycho-oncology services. This report outlines the clinically led development of UK-focused guidance to challenge psycho-oncology services to achieve and demonstrate their potential. It discusses how the guidance was particularly framed to encourage small, low-resource services, and outlines the potential benefits for patients. Overall, setting ourselves the challenge of quality on the same terms as physical healthcare, we can shape a direct path to achieving parity of esteem in mental with physical healthcare.

Current diagnostics and therapy recommendations for ocular basal cell carcinoma

The treatment options for basal cell carcinoma (BCC) have recently been augmented with the introduction of novel chemotherapeutic drugs. New S2guidelines on the disease have also been published. The aim of this article is to present acomprehensive state of the art description of the features of ocular BCC and an overview of the various therapeutic options. Particular emphasis is placed on the clinical signs, the diagnostic tools to identify periocular BCC and interpretation of the different histopathological subtypes. Tumor staging, TNM classification, interdisciplinary tumor conference reviews as well as psycho-oncological services play an important role in patients with pronounced periocular BCC. Surgical removal with ahistological R0resection is an important component of therapy options in this disease and includes the microsurgical excision into healthy tissue and the subsequent covering of the defect. Aspecial focus of this article is the treatment of locally extensive and metastasized BCC.

Gender differences in cancer-related distress in Japan: a retrospective observation study.

BackgroundCancer care is currently the most important medical issue in Japan. Total pain of cancer patients consists of a combination of four factors: physical, psychological, social distress, and spiritual pain. Previous studies showed female cancer patients ask for more psychological support and seem to suffer different types of distress compared with male patients, for example, appearance-related symptoms. However, other factors of cancer distress related to gender have not been defined comprehensively. The aim of this study is to clarify the gender differences in cancer distress types in order to elucidate the measures that should be taken in Japan to improve the quality of whole cancer care based on gender-based medicine.MethodsThe data of new patients who had visited the psycho-oncology outpatient service of Kinki University Hospital during the period of May 2013 to October 2015 were collected. Demographic factors and all assessed items were extracted from the patients’ medical charts retrospectively. Based on an inquiry of cancer patients in 2010, each item representing the four factors of “total pain” of cancer patients was chosen, i.e., physical distress (pain, changes in appearance), psychological distress (anxiety, depression), social distress (family problems, job-related problems), and spiritual pain; together with sexuality issues, and answers were analyzed. Hospital Anxiety Depression Scale (HADS) was used for the assessment of psychological distress. Chi-square test and Fisher’s exact test were performed for gender differences in the cancer distress types. Pearson’s analysis and multiple logistic regression analysis were performed for the association of gender with each item.ResultsThe data of 101 cancer patients were analyzed and there were more female patients than male patients (female: male ratio = 71:30). Female cancer patients were more likely to suffer from psycho-social issues such as changes in appearance, family problems and sexuality issues than male patients, and male patients were more likely to have spiritual pain.ConclusionsThere were gender differences in the distress types of cancer patients. In order to improve the quality of whole cancer care, more intensive intervention by medical professionals and social support is needed from the viewpoint of gender-based medicine and psycho-oncology.

Communication, Documentation, and Training Standards in Pediatric Psychosocial Oncology.

As part of a larger effort to create standards for psychosocial care of children with cancer, we document consensus and evidence-based data on interprofessional communication, documentation, and training for professionals providing psycho-oncology services. Six databases were searched. Sixty-five articles and six guidelines and consensus-based documents were identified; 35 met inclusion criteria. Data support strong recommendations for standards of care in communication/collaboration, documentation of patient information, and training in pediatric psycho-oncology. These are areas where extensive research is unlikely to be conducted; however, professional expectations and qualifications may be further clarified and strengthened with time.

Screening for Psychological Distress in Adult Primary Brain Tumor Patients and Caregivers: Considerations for Cancer Care Coordination.

This study aimed to assess psychological distress (PD) as scored by the Distress Thermometer (DT) in adult primary brain tumor patients and caregivers (CGs) in a clinic setting and ascertain if any high-risk subgroups for PD exist. From May 2012 to August 2013, n = 96 patients and n = 32 CG underwent DT screening at diagnosis, and a differing cohort of n = 12 patients and n = 14 CGs at first recurrence. Groups were described by diagnosis (high grade, low grade, and benign) and English versus non English speaking. Those with DT score ≥4 met caseness criteria for referral to psycho-oncology services. One-way ANOVA tests were conducted to test for between-group differences where appropriate. At diagnosis and first recurrence, 37.5 and 75.0% (respectively) of patients had DT scores above the cutoff for distress. At diagnosis, 78.1% of CGs met caseness criteria for distress. All CGs at recurrence met distress criterion. Patients with high-grade glioma had significantly higher scores than those with a benign tumor. For patients at diagnosis, non English speaking participants did not report significantly higher DT scores than English speaking participants. Psychological distress is particularly elevated in CGs and in patients with high-grade glioma at diagnosis. Effective PD screening, triage, and referral by skilled care coordinators are vital to enable timely needs assessment, psychological support, and effective intervention.

Correlates of oncologist-issued referrals for psycho-oncology services: what we learned from the electronic voluntary screening and referral system for depression (eVSRS-D).

Depression in cancer patients is under-recognized and under-treated. To better identify depression, we designed a voluntary depression screening system. Based on its data, we examined trends in oncologist-issued referrals for the psycho-oncology service (POS). The Electronic Voluntary Screening and Referral System for Depression (eVSRS-D) comprises self-screening, automated reporting, and referral guidance. Using touch-screen kiosks at a tertiary hospital in Korea, participants with cancer completed the Patient Health Questionnaire-9 at their convenience, received the results, and reported their willingness to participate in POS. At oncology appointments, oncologists received the screening reports and issued referrals following pre-recommended guidelines. The correlates of actual referrals were examined across all participants and within the willing and non-willing groups. Among the 838 participants, 56.3% reported severe depression symptoms, 30.5% wanted a referral, and 14.8% were actually referred. The correlates of participants' desire for referral were more severe depression symptoms, being unmarried, and being metastasis and recurrence free. Among all participants, the correlates of actual referrals were unemployment, less severe depression symptoms, poorer performance, treatment status, and wanting a referral. The sole correlate of actual referrals within the non-willing group was poorer performance, and no significant correlates existed within the willing group. The non-referrals were mostly (87.1%) because of postponed decisions. The eVSRS-D cannot definitively diagnose major depression but may efficiently self-select a population with significant depression symptoms. The patients' willingness to engage the POS most strongly predicted the actual referrals. Oncologist reviews of screening reports may not result in further depression severity-specific referrals.