COMMENTARY

Alleviate Cancer Survivor Distress: Screening and Psychosocial Care

Natasha Buchanan, PhD

Disclosures

June 20, 2016

Editorial Collaboration

Medscape &

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Hello. I'm Dr Natasha Buchanan, a behavioral scientist with the Epidemiology and Applied Research Branch in CDC's Division of Cancer Prevention and Control. Over the next few minutes I will share information about cancer survivorship in the United States, the prevalence of psychosocial distress among survivors, and what medical professionals can do to detect psychosocial concerns and refer patients to treatment and supportive care services when needed.

In the United States, 14.5 million men, women, and children were estimated to be living after a cancer diagnosis (cancer survivors) in 2014.[1] This number has more than doubled in the past 10 years, and the increase can largely be attributed to advancements in technology, treatment, and an aging US population. All phases of the cancer experience can cause distress for survivors, their family members, and other caregivers, from diagnosis to long-term follow-up after treatment. Distress is an unpleasant emotional experience of a psychosocial and/or spiritual nature that may interfere with one's ability to cope effectively with a disease, its physical symptoms, and its treatments.[2] Symptoms of distress can range from "normal feelings of vulnerability and sadness, to disabling conditions, such as depression, anxiety, panic, social isolation, and existential or spiritual crisis."[2]

The cancer experience may cause new psychosocial distress or exacerbate preexisting emotional, behavioral, and/or cognitive health concerns. Among those newly diagnosed with cancer and cancer survivors diagnosed with recurrent cancer, 20%-47% show a significant level of distress,[2,3] and 17%-75% of cancer survivors have reported concerns with memory, thinking, and attention just after or several years after the end of treatment.[3,4,5] The prevalence of psychosocial distress can vary by type of cancer, time since diagnosis, degree of physical impairment, amount of pain, prognosis, and other variables. Unfortunately, few cancer survivors (31%-37%) have had a discussion initiated by their doctors about psychosocial needs and concerns,[4,5,6] and even fewer are receiving treatment for distress.[4,7] Subsequently, less than half of distressed cancer survivors are actually identified and referred for psychosocial treatment and supportive services.

In recent years, such organizations as the Institute of Medicine (IOM),[8] the National Comprehensive Cancer Network (NCCN),[2] and the American College of Surgeons Commission on Cancer (ACoSCoC)[9] have recognized that quality cancer care must include identifying and addressing the patient's psychosocial needs. NCCN has recommended distress screening in all clinical settings for those with a history of cancer, whereas ACoSCoC has required distress screening for cancer patients treated in ACoS-accredited facilities.[2,9]

So, how can you ensure that your patients are appropriately screened for psychosocial distress and referred, when indicated, for treatment and supportive services?

Recommendations and standards of care[2,9] encourage providers to use standardized, validated measures with established cutoff scores to identify distressed patients. Providers, including oncologists, social workers, nurses, and psychologists, should select and administer distress screening measures that are most appropriate for their patient population and care facility.[10] All cancer survivors should be screened a minimum of once at a pivotal medical visit, to be determined by the medical care team.

Some of the most commonly used tools in oncology settings are the Hospital Anxiety and Depression Scale (HADS), the Brief Symptom Inventory-18 (BSI-18)[3] and the Distress Thermometer (DT). These instruments range from ultrashort to long or standard in length and are easy to use for a range of providers. The Distress Thermometer is available for use free of charge. Distress screening and psychosocial treatment are billable services and can be reimbursable by using Centers for Medicare & Medicaid Services codes.[11]

Once distress screening is conducted, survivors can be referred to psychosocial treatment and supportive care interventions according to their level of distress. For survivors with minimal distress, their needs may be met through psychoeducational or patient-to-patient support interventions. Survivors with more profound distress may benefit from crisis intervention, support groups, short-term or long-term psychotherapy, and/or pharmacologic treatments.[3,4,10]

Please, urge your patients to receive distress screening and psychosocial treatment, when indicated, as an important part of their care. You have a real opportunity to reduce the psychosocial imprint of cancer and help survivors to live happy, healthier lives. Please visit www.cdc.gov/cancer for more information. Thank you.

Web Resources

Cancer Prevention and Control

Cancer Survivorship

Hospital Anxiety and Depression Scale (HADS)

Distress Thermometer (DT)

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