Early assessment of distress in cancer patients treated in DH setting

Abstract

According to NCCN vers. 1.2014, distress is a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional) social and spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling such as depression, anxiety, panic, social isolation, and existential and spiritual crisis. Although largely under-recognized, distress is the sixth vital sign and is reported in 30-40% of newly diagnosed cancer patients. To assess the level of distress in newly diagnosed cancer pts receiving chemotherapy in our DH, between 1st and 2nd course, patients were screened by mean of self administered tools (Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer and Problem List (DT-PL)) followed by a clinical interview. HADS is a 14 items measure of anxiety (7 items) and depression (7 items). DT is a visual analogue tool evaluating the level of distress in the last week on a scale from 0 to 10. PL is a 36 problems list grouped into 5 categories. The clinical interview is aimed to express any potential needs and to plan interventions including home assistance, volunteer support, mental health and to encourage more structured psychological support. Between October 2014 and April 2015, 94 pts were evaluated, 3 pts declined to partecipate. Characteristics of evaluated pts were: median age 64yrs (range 38-89), 55 females and 39 males; 27 pts have <5 yrs of education, 32 8 yrs, 30 <13 yrs, 5 >13 yrs of education; professional status: 56 were retired, 29 employed, 9 unemployed or housewives; tumor type 28 colorectal, 17 breast, 9 lung, 10 gynecologic, 30 other solid tumors. We observed sign of anxiety and depression in 43.62% and 29.79% respectively. Probable levels of anxiety and depression were present in 20.21% and 11.70% and possible levels in 23.41% and 18.09% respectively. 13.8% were administered more structured psychological intervention. Our findings suggest that evaluation of anxiety and depression is feasible and may be included in routine oncological work up of newly diagnosed pts, health care providers should be aware and receive training to better address distress complains in cancer pts.