Distress screening and management in oncology patients Elizabeth - - PowerPoint PPT Presentation

Distress screening and management in oncology patients

Elizabeth Guancial, MD Sandy Sabatka, MLCSW

WCI Survivorship Symposium January 23, 2016

Learning Objectives:

• 1. Define distress and how to assess for it.
• 2. Describe WCI rates of distress.
• 3. Highlight local resources for distress

management in cancer survivors.

What is distress?

“Multifactorial, unpleasant, emotional experience of psychological, social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its symptoms, and treatment”

Holland et al. J Natl Comp Canc Netw. 2013.11: 190.

What is the goal of distress screening?

Prospectively identify and triage cancer patients at risk for illness-related biopsychosocial complications that undermine the ability to benefit from medical care.

Holland et al. J Natl Comp Canc Netw. 2013.11: 190.

Global implications of distress

• Reduced HRQoL1
• Dissatisfaction with medical care2
• Cancer mortality3

Shim et al. Breast Cancer Res Treat. 2006; 99: 341. Von Essen et al. Eur J Cancer Care. 2002; 11: 91. Pinquart and Duberstein. Psychol Med. 2010; 40: 1797. Hamer et al. J. Psychosom. Res 2009; 66: 255.

Why now?

• 1.6 million anticipated cancer diagnoses in US in 2016
• Distress identified in 30-40% of patients at some point

during their course of oncology care

• 70% cared for at centers accredited by the American

College of Surgeons Commission on Cancer (WCI)

American College of Surgeons. Cancer Program Standards 2012.

The Wilmot Cancer Institute will be the leading regional cancer center and rank among the nation's premier comprehensive cancer centers by providing:

• World-class research in the prevention, detection and treatment of cancers and

their related conditions

• Comprehensive and compassionate care, in a multidisciplinary approach,

that is responsive to the needs of our patients and their families

• Renowned teaching to ensure exceptional cancer care and research for future

generations

• Information and education to improve the health and welfare of our community
• A dynamic and progressive atmosphere responsive to the needs of our

patients and community

Our Vision

Value of distress screening

Benefit to patient:

• Gives them a voice/common language
• De-stigmatizes request for help
• Connection to resources
• Improves continuity of care for

psychosocial symptoms

Benefit to healthcare team:

• Raises standard for clinical care
• Helps anticipate workload
• Identifies patients at risk for disruption
• f clinical services, “no show”
• Streamlines triage and referral for

supportive care services

Value of distress screening

• Generation of data to study:
• Treatment compliance
• Disease-related outcomes
• Healthcare utilization/cost
• Directly supports academic mission of excellence in education,

research, patient care

• Abstracts presented at Genitourinary American Society of Clinical Oncology

meeting 2016 and Breast cancer symposium 2015

WCI Distress Management Advisory Committee

• Founded in 2013 with goal of meeting new ACS standard of

distress screening by 2015

• Committee composition
• Participated in two NCI/City of Hope-sponsored workshops

DMAC

Committee goals- Phase I:

1)

Select valid and reliable screening tool

2)

Create resource list and plan to address psycho-social needs

3)

Operationalize use and documentation in clinic workflow

4)

Educate staff and patients (promote “buy-in”)

5)

Coordinate system-wide implementation

6)

Audit staff and provide ongoing re-education

DMAC

Committee goals- Phase II:

1)

Develop policies and procedures for use

2)

Collect and analyze data

3)

Support research and quality improvement projects through creation of a Data Use Agreement

4)

Overseeing transition to electronic screening in WCC

Screening tool for distress

NCCN Distress Thermometer

Screening work flow

Distress Screen Score I nterpretation

Red Zone Score 7-10 Yellow Zone Score of 4-6 Green Zone Score 0-3

• Considered mild
• Patient is managing the

concern(s) well and has low distress

• Warning signal
• Response required
• Patient in high distress
• Response required
• More thorough

immediate assesment

For All Patients 1. Review screen and acknowledged score 2. Discuss with patient 3. Chart conversation 4. Follow through on action plan identified (ie. referral to Social Work, Palliative Care, Nutrition, Pain Clinic etc.)

Wilmot Cancer Institute Data

1506 patients screened (6/03/14-11/20/15) using NCCN DT tool 37.78% (569 of 1506 patients) scored a 4 or above

WCI Data

Score # of Screens % of screens 4 or above 4 101 17% 5 146 26% 6 82 14% 7 89 16% 8 84 14% 9 23 4% 10 44 8%

Most Frequently Reported Problems on DT

Psychosocial: Worry 41% overall most indicated of all categories Nervousness 35% Fears 24% Physical: Fatigue 39% Sleep 31% Pain 28%

WCI PROMIS pilot data

• 275 completed by 129 individual patients (7/1-11/30/15)
• 28% new patients (NP), 82% follow-ups (FP)
• Median time to completion: 3.77 minutes
• Guancial. GU ASCO. 2016.

WCI PROMIS pilot data

• Guancial. GU ASCO. 2016.

Times of High Stress

• Immediately after diagnosis
• Waiting for appointments & results
• 2-3 months after primary treatment
• 1-2 years after primary treatment
• Prior to follow up appointments, scans & tests
• Finding out someone else is diagnosed with cancer

Mild to Moderate Stress

Resources For Patients & Families

• WCI Oncology Social Worker
• WCI Support Groups
• American Cancer Society

(800) 227-2345

• Gilda’s Club Rochester

(585) 423-9700

• Breast Cancer Coalition of Rochester

(585) 473-8177

• Us Too Rochester, NY

(585) 787-4011

Implementing Distress Screening

Standard 3 .2 Psychosocial Distress Screening Com m ission on Cancer Program Standards 2 0 1 2 http: / / www.youtube.com/ watch?v= m5PE-i-0jOo