Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers.

Routine distress screening in United States oncology clinics has been mandatory since 2015. OBJECTIVE: This study was the first to assess distress in a geographically diverse sample of cancer patients following mandated distress screening implementation by oncology social workers. METHODS: Sites were self-selected via social workers who applied to participate in the Association of Oncology Social Work's Project to Assure Quality Cancer Care, advertised through their social media outlets and conference. Electronic screening records were collected from 55 cancer treatment centers in the United States and Canada. Cases required cancer diagnoses and Distress Thermometer (DT) scores to be included. Distress rates and rates by age, sex, cancer type, and ethnicity were examined. RESULTS: Of 4664 cases, 46% (2157) experienced significant distress (DT score ≥ 4). Being female, age 40-59, and having diagnoses of pancreatic or lung cancer was associated with increased likelihood of distress. Half of cases experience clinically-significant distress, though this need was not evenly distributed across patient or cancer types. CONCLUSION: Identifying those at risk for distress may help inform optimal resource allocation. Methods to address needs of distressed patients in cases of limited resources are discussed.

The Association of Oncology Social Work's Project to Assure Quality Cancer Care (APAQCC).

In 2014, the Association for Oncology Social Work (AOSW) established A Project to Assure Quality Cancer Care (APAQCC), a group of oncology social workers representing sixty-five Commission on Cancer (CoC)-accredited cancer programs across the US (including two in Canada). Its aims were (1) to examine the capacity of cancer programs to provide quality psychosocial support services, and (2) to evaluate the implementation of distress screening. The purpose of this paper is to describe how this collaborative research program was created and implemented under the auspices of AOSW, and to report on its impact on the oncology social workers who participated.

A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization.

Background: This study examined the extent to which cancer programs demonstrated adherence to their own prescribed screening protocol, and whether adherence to that protocol was associated with medical service utilization. The hypothesis is that higher rates of service utilization are associated with lower rates of adherence to screening protocols. Methods: Oncology social workers at Commission on Cancer-accredited cancer programs reviewed electronic health records (EHRs) in their respective cancer programs during a 2-month period in 2014. Rates of overall adherence to a prescribed distress screening protocol were calculated based on documentation in the EHR that screening adherence and an appropriate clinical response had occurred. We examined documentation of emergency department (ED) use and hospitalization within 2 months after the screening visit. Results: Review of 8,409 EHRs across 55 cancer centers indicated that the overall adherence rate to screening protocols was 62.7%. The highest rates of adherence were observed in Community Cancer Programs (76.3%) and the lowest rates were in NCI-designated Cancer Centers (43.3%). Rates of medical service utilization were significantly higher than expected when overall protocol adherence was lacking. After controlling for patient and institutional characteristics, risk ratios for ED use (0.82) and hospitalization (0.81) suggest that when overall protocol adherence was documented, 18% to 19% fewer patients used these medical services. Conclusions: The observed associations between a mandated psychosocial care protocol and medical service utilization suggest opportunities for operational efficiencies and costs savings. Further investigations of protocol integrity, as well as the clinical care models by which psychosocial care is delivered, are warranted.

First Descents, an adventure program for young adults with cancer: who benefits?

BACKGROUND: Participation in camps, adventure programs, retreats, and other social events offers experiences that can promote self-efficacy and quality of life. PURPOSE: The purpose of the study was to examine whether participation in a 1-week outdoor adventure program resulted in improvements in psychological distress, self-efficacy, and/or social support for young adult cancer patients (AYAs) aged 18-40 years. The study examined the differential effect of participation for AYAs who indicated moderate to severe symptoms of psychological distress prior to their trip. METHODS: Standardized measures of distress, self-efficacy, and social support were administered pre-trip, post-trip, and 1 month after program completion (follow-up). Univariate and multivariate models examined baseline scores for non-distressed participants compared to distressed participants, changes in outcomes from pre-trip to post-trip and follow-up for the entire sample, and the extent to which change rates for each outcome differed for distressed versus non-distressed participants. RESULTS: All participants demonstrated significant improvement in self-efficacy over time. Distressed participants reported a significantly greater decrease in distress symptoms and greater increase in self-efficacy and social support at post-trip and 1 month later when compared to non-distressed participants. CONCLUSIONS: Findings suggest that participation in an outdoor recreational activity designed specifically for AYAs with cancer contributes to significant reductions in distress and improvements in self-efficacy and social support, and particularly for AYAs reporting clinically significant distress symptoms prior to the initiation of their activity.

Institutional capacity to provide psychosocial oncology support services: A report from the Association of Oncology Social Work.

BACKGROUND: This study reports cancer-treating institutions' capacity to deliver comprehensive psychosocial support services. METHODS: Oncology care providers at 60 cancer-treating institutions completed surveys assessing the capacity of their institutions to provide psychosocial care. Capacity was assessed with the Cancer Psychosocial Care Matrix (CPCM) from the National Cancer Institute (NCI). Scores represented individuals' perceptions of their cancer program's performance with respect to 10 fundamental elements of psychosocial care. RESULTS: Among 2134 respondents, 62% reported a mid-level capacity for ≥5 of 10 CPCM items. In comparison with other types of cancer programs (eg, NCI-designated, academic, or comprehensive centers), providers at community cancer programs reported a significantly greater capacity with respect to patient-provider communication, psychosocial needs assessment, and continuity in the delivery of psychosocial care over time. Nurses and primary medical providers reported a significantly lower capacity for linking patients and families with needed psychosocial services within their respective cancer programs. They also reported a significantly higher capacity for conducting follow-up, re-evaluations, and adjustments of psychosocial treatment plans. CONCLUSIONS: Cancer programs are performing moderately well in terms of communicating to patients the importance of psychosocial care, identifying patient psychosocial needs, and referring patients and families to psychosocial services. They are doing less well with respect to the provision of that care over time. Findings suggest that gaps in psychosocial service capacity are a function of patient, provider, and system characteristics. These results may be useful in formulating strategies to enhance psychosocial care delivery. Cancer 2016;122:1937-45. © 2016 American Cancer Society.

Psychosocial distress screening implementation in cancer care: an analysis of adherence, responsiveness, and acceptability.

PURPOSE: The American College of Surgeons Commission on Cancer has mandated implementation of a systematic protocol for psychosocial distress screening and referral as a condition for cancer center accreditation beginning in 2015. Compliance with standards requires evidence that distress screening protocols are carried out as intended and result in appropriate referral and follow-up when indicated. The purpose of this study was to examine the fidelity of distress screening protocols at two tertiary cancer treatment centers. METHODS: A retrospective review and analysis of electronic medical records over a 12-week period examined clinic adherence to a prescribed distress screening protocol and responsiveness to patients whose scores on the National Comprehensive Cancer Network Distress Thermometer (DT) indicated clinically significant levels of distress requiring subsequent psychosocial contact. A weekly online survey assessed clinician perspectives on the acceptability of the protocol. RESULTS: Across clinics, rates of adherence to the distress screening protocol ranged from 47% to 73% of eligible patients. For patients indicating clinically significant distress (DT score ≥ 4), documentation of psychosocial contact or referral occurred, on average, 50% to 63% of the time, and was more likely to occur at one of two participating institutions when DT scores were high (DT score of 8 to 10). Clinician assessments of the protocol's utility in addressing patient concerns and responding to patient needs were generally positive. CONCLUSION: Systematic tracking of distress screening protocols is needed to demonstrate compliance with new standards of care and to demonstrate how well institutions are responding to their clinical obligation to address cancer patients' emotional and psychosocial needs.