Screening for psychological distress in follow-up care to identify head and neck cancer patients with untreated distress

Anne-Marie H Krebber, Femke Jansen, Pim Cuijpers, C René Leemans, Irma M Verdonck-de Leeuw, Anne-Marie H Krebber, Femke Jansen, Pim Cuijpers, C René Leemans, Irma M Verdonck-de Leeuw

Abstract

Purpose: The purpose of the study is to investigate screening in follow-up care to identify head and neck cancer (HNC) patients with untreated psychological distress.

Methods: From November 2009 until December 2012, we investigated the use of OncoQuest (a touch screen computer system to monitor psychological distress (Hospital Anxiety and Depression Scale (HADS)) and quality of life (HRQOL; EORTC QLQ-C30 and H&N35 module) in routine follow-up care. Patients who screened positive for psychological distress (HADS-T >14, HADS-A >7, or HADS-D >7) were asked whether they received psychological or psychiatric treatment.

Results: During the study period of 37 months, OncoQuest was used by 720 individual HNC patients, of whom 714 had complete HADS data. Psychological distress was present in 206 patients (29 %). Of those patients who fulfilled in- and exclusion criteria (n = 137), 25 received psychological treatment (18 %). Receipt of psychological treatment was significantly related to a higher score on the HADS total scale (19.6 vs. 16.9; p = 0.019), a lower (worse) score on the EORTC QLQ-C30 scale emotional functioning (46.0 vs. 58.6; p = 0.023), a higher (worse) score on fatigue (58.2 vs. 46.4; p = 0.032), problems with sexuality (44.1 vs. 34.4; p = 0.043), oral pain (43.8 vs. 28.8; p = 0.011) and speech problems (37.0 vs. 25.3; p = 0.042).

Conclusions: Screening for psychological distress via OncoQuest is beneficial because 82 % of HNC patients identified with an increased level of distress who do not yet receive mental treatment were identified. Patients who did receive treatment reported more distress and worse quality of life, which may be explained because patients with more severe problems maybe more inclined to seek help or might be detected easier by caregivers and referred to supportive care more often.

Keywords: Anxiety; Depression; Head and neck cancer; Oncology; Screening for psychological distress.

Figures

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Fig. 1
Selection of patients

References

    1. Fitch MI. Supportive care framework. Can Oncol Nurs J. 2008;18:6–24. doi: 10.5737/1181912x181614.
    1. Comprehensive Cancer Centre the Netherlands (IKNL) (2011) Guideline Oncological rehabilitation. Accessed June 29, 2015
    1. Comprehensive Cancer Centre the Netherlands (IKNL) (2010) Guideline Detection of need for psychosocial care. Accessed June 29, 2015
    1. Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL. Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. J Natl Cancer Inst. 2012;104:990–1004. doi: 10.1093/jnci/djs256.
    1. Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol. 2013;31:782–793. doi: 10.1200/JCO.2011.40.8922.
    1. Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donnelly M. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database Syst Rev. 2012;11:CD007064.
    1. Verdonck-de Leeuw IM, de Bree R, Keizer AL, Houffelaar T, Cuijpers P, van der Linden MH, Leemans CR. Computerized prospective screening for high levels of emotional distress in head and neck cancer patients and referral rate to psychosocial care. Oral Oncol. 2009;45:e129–133. doi: 10.1016/j.oraloncology.2009.01.012.
    1. Waller A, Williams A, Groff SL, Bultz BD, Carlson LE. Screening for distress, the sixth vital sign: examining self-referral in people with cancer over a one-year period. Psychooncology. 2013;22(2):388–395.
    1. Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD. High levels of untreated distress and fatigue in cancer patients. Br J Cancer. 2004;90:2297–2304.
    1. Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ. What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer. 2009;17:1117–1128. doi: 10.1007/s00520-009-0615-5.
    1. Maguire R, Papadopoulou C, Kotronoulas G, Simpson MF, McPhelim J, Irvine L. A systematic review of supportive care needs of people living with lung cancer. Eur J Oncol Nurs. 2013;17:449–464. doi: 10.1016/j.ejon.2012.10.013.
    1. Carlson LE, Waller A, Mitchell AJ. Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol. 2012;30:1160–1177. doi: 10.1200/JCO.2011.39.5509.
    1. Donovan KA, Jacobsen PB. Progress in the implementation of NCCN guidelines for distress management by member institutions. J Natl Compr Canc Netw. 2013;11:223–226.
    1. Mitchell AJ, Kaar S, Coggan C, Herdman J. Acceptability of common screening methods used to detect distress and related mood disorders-preferences of cancer specialists and non-specialists. Psychooncology. 2008;17:226–236. doi: 10.1002/pon.1228.
    1. Fitch MI. Screening for distress: a role for oncology nursing. Curr Opin Oncol. 2011;23:331–337. doi: 10.1097/CCO.0b013e32834791a1.
    1. Mitchell AJ. Screening for cancer-related distress: when is implementation successful and when is it unsuccessful? Acta Oncol. 2013;52:216–224. doi: 10.3109/0284186X.2012.745949.
    1. Mitchell AJ. Short screening tools for cancer-related distress: a review and diagnostic validity meta-analysis. J Natl Compr Canc Netw. 2010;8:487–494.
    1. Snyder CF, Jensen R, Courtin SO, Wu AW. PatientViewpoint: a website for patient-reported outcomes assessment. Qual Life Res. 2009;18:793–800. doi: 10.1007/s11136-009-9497-8.
    1. Loscalzo M, Clark K, Dillehunt J, Rinehart R, Strowbridge R, Smith D. SupportScreen: a model for improving patient outcomes. J Natl Compr Canc Netw. 2010;8:496–50.
    1. Berry DL, Blumenstein BA, Halpenny B, Wolpin S, Fann JR, Austin-Seymour M, Bush N, Karras BT, Lober WB, McCorkle R. Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. J Clin Oncol. 2011;29:1029–1035. doi: 10.1200/JCO.2010.30.3909.
    1. Holzner B, Giesinger JM, Pinggera J, Zugal S, Schopf F, Oberguggenberger AS, Gamper EM, Zabernigg A, Weber B, Rumpold G. The Computer-based Health Evaluation Software (CHES): a software for electronic patient-reported outcome monitoring. BMC Med Inform Decis Mak. 2012;12:126. doi: 10.1186/1472-6947-12-126.
    1. Cnossen IC, de Bree R, Rinkel RN, Eerenstein SE, Rietveld DH, Doornaert P, Buter J, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM. Computerized monitoring of patient-reported speech and swallowing problems in head and neck cancer patients in clinical practice. Support Care Cancer. 2012;20:2925–2931. doi: 10.1007/s00520-012-1422-y.
    1. de Bree R, Verdonck-de Leeuw IM, Keizer AL, Houffelaar A, Leemans CR. Touch screen computer-assisted health-related quality of life and distress data collection in head and neck cancer patients. Clin Otolaryngol. 2008;33:138–142. doi: 10.1111/j.1749-4486.2008.01676.x.
    1. Carlson LE, Groff SL, Maciejewski O, Bultz BD. Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol. 2010;28:4884–4891. doi: 10.1200/JCO.2009.27.3698.
    1. Carlson LE, Waller A, Groff SL, Bultz BD. Reply: comment on ‘Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage’—psychological distress in patients with cancer: is screening the effective solution? Br J Cancer. 2013;108:2631–2632. doi: 10.1038/bjc.2013.287.
    1. Carlson LE, Waller A, Groff SL, Bultz BD. Screening for distress, the sixth vital sign, in lung cancer patients: effects on pain, fatigue, and common problems—secondary outcomes of a randomized controlled trial. Psychooncology. 2013;22:1880–1888. doi: 10.1002/pon.3223.
    1. Howell D, Hack TF, Green E, Fitch M. Cancer distress screening data: translating knowledge into clinical action for a quality response. Palliat Support Care. 2014;12:39–51. doi: 10.1017/S1478951513000382.
    1. Coyne JC. Benefits of screening cancer patients for distress still not demonstrated. Br J Cancer. 2013;108:736–737. doi: 10.1038/bjc.2013.16.
    1. Palmer SC, Taggi A, Demichele A, Coyne JC. Is screening effective in detecting untreated psychiatric disorders among newly diagnosed breast cancer patients? Cancer. 2012;118:2735–2743. doi: 10.1002/cncr.26603.
    1. Palmer SC, van Scheppingen C, Coyne JC. Clinical trial did not demonstrate benefits of screening patients with cancer for distress. J Clin Oncol. 2011;29:e277–278. doi: 10.1200/JCO.2010.34.1206.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27:363–370. doi: 10.1017/S0033291796004382.
    1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–376. doi: 10.1093/jnci/85.5.365.
    1. Bjordal K, Ahlner-Elmqvist M, Tollesson E, Jensen AB, Razavi D, Maher EJ, Kaasa S. Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. EORTC Quality of Life Study Group. Acta Oncol. 1994;33:879–885. doi: 10.3109/02841869409098450.
    1. Fayers P, Bottomley A, Group EQoL, Unit QoL Quality of life research within the EORTC-the EORTC QLQ-C30. European Organisation for Research and Treatment of Cancer. Eur J Cancer. 2002;38(Suppl 4):S125–133. doi: 10.1016/S0959-8049(01)00448-8.
    1. Verdonck-de Leeuw IM, Eerenstein SE, Van der Linden MH, Kuik DJ, de Bree R, Leemans CR. Distress in spouses and patients after treatment for head and neck cancer. Laryngoscope. 2007;117:238–241. doi: 10.1097/01.mlg.0000250169.10241.58.
    1. Weissman MM, Neria Y, Gameroff MJ, Pilowsky DJ, Wickramaratne P, Lantigua R, Shea S, Olfson M. Positive screens for psychiatric disorders in primary care: a long-term follow-up of patients who were not in treatment. Psychiatr Serv. 2010;61:151–159. doi: 10.1176/ps.2010.61.2.151.
    1. Kotronoulas G, Kearney N, Maguire R, Harrow A, Di Domenico D, Croy S, MacGillivray S. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol. 2014;32:1480–1501. doi: 10.1200/JCO.2013.53.5948.
    1. Luckett T, Butow PN, King MT. Improving patient outcomes through the routine use of patient-reported data in cancer clinics: future directions. Psychooncology. 2009;18:1129–1138. doi: 10.1002/pon.1545.
    1. Jansen F, van Uden-Kraan CF, van Zwieten V, Witte BI, Verdonck-de Leeuw IM. Cancer survivors’ perceived need for supportive care and their attitude towards self-management and eHealth. Support Care Cancer. 2015;23:1679–88. doi: 10.1007/s00520-014-2514-7.
    1. Lubberding S, van Uden-Kraan CF, Te Velde EA, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM. Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors. J Clin Nurs. 2015;24:1367–79. doi: 10.1111/jocn.12753.
    1. Krebber AM, Leemans CR, de Bree R, van Straten A, Smit F, Smit EF, Becker A, Eeckhout GM, Beekman AT, Cuijpers P, Verdonck-de Leeuw IM. Stepped care targeting psychological distress in head and neck and lung cancer patients: a randomized clinical trial. BMC cancer. 2012;12:173. doi: 10.1186/1471-2407-12-173.
    1. Carlson LE, Waller A, Groff SL, Zhong L, Bultz BD. Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage. Br J Cancer. 2012;107:617–625. doi: 10.1038/bjc.2012.309.

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