Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program

Abstract

Objectives/hypothesis: Psychosocial distress is common among patients with head and neck cancer (HNC) and is associated with poorer quality of life and clinical outcomes. Despite these risks, distress screening is not widely implemented in HNC care. In this study, we investigated the prevalence of psychosocial distress and its related factors in routine care of patients with HNC.

Methods: Data from medical records between September 2017 and March 2020 were analyzed. Psychosocial distress was measured by the National Comprehensive Cancer Network's Distress Thermometer (DT), and a modified HNC-specific problem list; depression and anxiety were assessed using the Patient Health Questionnaire-4. Descriptive statistics and logistic regression were conducted to report prevalence of distress, depression and anxiety, and factors associated with clinical distress. Implementation outcomes, including rates of referrals and follow-up for distressed patients, are also reported.

Results: Two hundred and eighty seven HNC patients completed the questionnaire (age 64.3 ± 14.9 years), with a mean distress score of 4.51 ± 3.35. Of those, 57% (n = 163) reported clinical distress (DT ≥ 4). Pain (odds ratio [OR] = 3.31, 95% CI = 1.75-6.26), fatigue (OR = 2.43, 95% CI = 1.1.7-5.05), anxiety (OR = 1.63, 95% CI = 1.30-2.05), and depression (OR = 1.51, 95% CI = 1.04-2.18) were significantly associated with clinical distress (P < .05). Of patients identified as distressed, 79% received same-day psychosocial evaluation.

Conclusions: Clinical distress was identified in 57% of patients who completed the questionnaire, suggesting that an ultra-brief psychosocial screening protocol can be implemented in routine ambulatory oncology care, and identifies patients whose distress might otherwise go unrecognized.

Level of evidence: 4 Laryngoscope, 132:1600-1608, 2022.

Keywords: Distress screening; depression; head and neck cancer.

Figure 1.. UCLA HNCP Distress Screener (HNCP-DS) Questionnaire.

The questionnaire is comprised of three brief screening tools: (1) the NCCN Distress Thermometer (DT) (left), (2) a modified version of the DT Problem List (PL) (upper right), and (3) the Patient Health Questionnaire-4 (PHQ-4) (lower right). A DT score of >4 indicated clinically significant distress and triggered same day evaluation by the Mind-Body Team.

Figure 2.. Identification and referral outcomes of distressed patients.

Two pathways were utilized to identify distressed patients: (1) Clinician assessment and referral for psychosocial evaluation and (2) formal screening using the UCLA HNCP-DS. Distress was defined as DT of ≥4 on the HNCP-DS. Patients identified as distressed by clinician judgment (black), screening questionnaire (white), and both (grey) are shown, as are the proportion of patients who received same-day evaluation by the Mind-Body Team.