Computerized prospective screening for high levels of emotional distress in head and neck cancer patients and referral rate to psychosocial care
Introduction
Head and neck squamous cell carcinoma (HNSCC) patients often have to deal with side-effects of treatment, such as pain, fatigue, dry mouth, and speech and swallowing problems, negatively affect health-related quality of life (HRQOL).1 Emotional distress is also common.[2], [3], [4], [5], [6], [7] During the first year after treatment there is a gradual improvement of emotional functioning,[8], [9], [10] but many patients continue to suffer from or develop distress[11], [12], [13] and it is estimated that almost 30% suffer from distress.14 In cancer care, emotional distress is argued to be the sixth vital sign (besides temperature, respiration, heart rate, blood pressure, and pain) as a marker of health and well-being and as a target outcome measure.15 A recent study revealed that support groups, psycho-education and cognitive behavioral psychotherapy may be effective to improve emotional distress.16 Because the number of patients living with cancer is expected to increase dramatically due to the ageing population and improved (early) diagnostics and treatment, the need for psychosocial intervention will increase accordingly. However, in clinical practice heightened distress often goes unrecognized by oncological care professionals, especially those working in the field of head and neck cancer.17 As a result there are high levels of untreated distress in cancer patients.18 Implementation of efficient screening techniques becomes essential in clinical practice to enable adequate referral to psychosocial care. Information on referral rates in HNSCC cancer patients is lacking. The goals of the present study are: (1) to assess prospectively the prevalence of a high level of emotional distress in HNSCC patients as assessed by a newly developed touch screen computer-assisted system, (2) to investigate the factors that contribute to a high level of distress at baseline and after treatment, and (3) to assess current referral rates to psychosocial care. Results will contribute to better insight into the feasibility of screening distress in clinical practice and possibly unmet needs for psychosocial care.
Section snippets
Patients
From May 2006 to June 2007, 55 consecutive newly diagnosed HNSCC patients were asked to participate. The inclusion criterium was curative treatment for HNSCC. Exclusion criteria were: diseases causing cognitive dysfunction and poor understanding of the Dutch language. Age, gender, comorbidity, tumor site and stage, and treatment modality were recorded. Comorbidity was assessed with the Adult Comorbidity Evaluation 27 (ACE-27). The ACE-27 was designed specifically for cancer patients and
Patients
The patient group consisted of 38 males and 17 females (mean age 63 years (range 42–86)). Comorbidity (stage 0) was absent in 27 patients, 23 patients were classified in stage 1 (mild), 4 patients in stage 2 (moderate), and 1 patient in stage 3 (severe) (this patient was added to stage 2 for statistical analyses). Tumor site included larynx/hypopharynx (n = 22), oral/oropharynx cancer (n = 18), nasopharynx (n = 5), parotid glands (n = 2) and other (n = 8) (the last three categories were combined for
Discussion
Prospective screening for emotional distress via a touch screen computer system revealed that 18% of the patients had a high level of distress at time of diagnosis versus 25% after treatment. This is comparable with previous data on prevalence of distress in HNSCC patients as assessed by a conventional pen and paper method14, indicating that routine screening for distress via a touch screen computer system is feasible and reliable. Other studies also found that computer based HRQOL
Conflict of Interest Statement
None declared.
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