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Beyond the Diagnosis: Exploring the Multifaceted Distress Profile of Patients With Cancer
Jessica Neeb, MSN, RN, OCN; Puneeth Indurlal, MD, MS
Citation:
Abstract 1854763
Background
Health-related social needs (HRSN) are impediments to optimal patient outcomes and experiences. Practices in The US Oncology Network (The Network) use the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) as the screening tool to capture HRSNs. We studied the profile of distress reported by patients with cancer.
Methods
Data from the NCCN DT for 7 practices in The Network between July and December 2023 was used to evaluate the positive finding rate, types of distress reported, correlations between concerns, and the differences between problems when distress scores were ≥ 4 (the generally accepted threshold for clinically significant distress) or < 4. Screenings were conducted at different points in the care continuum depending on practice standards and preferences.
Results
Of 269 666 screenings conducted for 219 720 unique patients, 43.5% had a positive finding (≥ 1 problem [38.5%] reported or a distress score ≥ 1 [27.2%]), with 11.6% having a score of ≥ 4. Key metric comparisons between screenings with scores < 4 and ≥ 4 is provided in Table 1.
Table 1. Key Metric Comparisons Between Screenings With Scores < 4 and ≥ 4
| Score < 4 | Score ≥ 4 | |
| % of Screenings With Problems Reported | 31% | 93% |
| Average # of Problems Reported | 1.7 | 4.0 (P < 0.001) |
| % of screenings With Top 6 Problems Reported | ||
| Emotional - Worry or anxiety | 25.3% | 58.8% |
| Physical - Fatigue | 36.6% | 53.2% |
| Physical - Pain | 32.3% | 48.4% |
| Physical - Sleep | 25.8% | 43.3% |
| Emotional - Sadness or depression | 10.7% | 35.7% |
| Physical - Memory or concentration | 14.8% | 27.5% |
Emotional concerns were more commonly reported and more strongly correlated (Pearson correlation coefficient [PCC]) with scores ≥ 4, whereas physical concerns dominated with scores < 4. PCC for the top five reported problems by score category is in Table 2.
Table 2. PCC for the Top Five Reported Problems by Score Category
| Score < 4 | r | Score ≥ 4 | r |
| Emotional - Worry or anxiety | 0.2936 | Emotional - Sadness or depression | 0.2231 |
| Physical - Fatigue | 0.2515 | Emotional - Fear | 0.2059 |
| Physical - Pain | 0.2181 | Emotional - Anger | 0.1983 |
| Physical - Sleep | 0.2110 | Emotional - Loss of interest or enjoyment | 0.1916 |
| Practical - Finances | 0.1641 | Emotional - Feelings of worthlessness or being a burden | 0.1838 |
A distress action plan was documented for 55.7% of screenings with a positive finding, of which a majority (79.6%) were recorded as patients declining any assistance. 11.2% of screenings with a positive finding had an action plan with a referral for support services (social support). Only 2.2% of screenings with a score < 4 had social support referrals, contrasting with 34.4% of screenings with score ≥ 4. 5.5% of screenings with < 4 problems had social support referrals, vs 21.8% with ≥ 4 problems reported.
Conclusion
Cancer diagnosis and treatment can bring about numerous challenges, leading to a wide range of distressing experiences for patients. Understanding the multifaceted and complex nature of distress is crucial for health care professionals, caregivers, and support systems to coordinate social support services. A comprehensive and holistic approach that addresses the intertwined aspects of distress can help alleviate the burden experienced by cancer patients and improve their overall well-being and quality of life.
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