Severe Distress in Cancer Patients Affected Radiation Treatment

Patients who reported severe distress were more likely to miss radiation therapy appointments and be hospitalized during the course of their therapy compared with patients with lower distress scores, according to the results of a study (abstract 22) presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, held September 24–27 in San Diego.

According to the study, the National Comprehensive Cancer Network currently recommends use of a distress thermometer and problem list surveys to measure patient distress and communicate concerns to healthcare providers.

“Focusing on the ‘whole patient’ allows oncologists to deliver the best possible treatment. We know that having cancer is stressful, which means that we have a responsibility to consider a patient’s mental well-being when planning a course of action with them,” said Justin Anderson, lead author of the study and a medical student at the Virginia Commonwealth University School of Medicine in Richmond, in a press release. “While distress does not directly impact a patient’s disease, it impacts how she or he copes with treatment, such as the ability to follow a doctor’s recommendations and adhere to a treatment plan.”

Anderson and colleagues conducted this study to look for links between radiation-specific treatment and distress. From 2015 to 2016, all patients receiving treatment in the researchers’ department of radiation oncology completed distress score surveys (n = 129). All patients were undergoing external beam radiotherapy with definitive intent. The survey asked patients to rate “how much distress [they] have been experiencing in the past week including today,” on a scale from 0 (no distress) to 10 (extreme distress). Patients were grouped by distress score category: severe (7–10), moderate (4–6), low (1–3), and none (0).

Of the patients who completed distress score surveys, 54 received definitive treatment and were included in this analysis. Fifteen percent of patients had severe distress, 29% had moderate distress, 29% had low distress, and 25% had no distress.

A significant association was identified between severe distress score and missing at least one appointment. Of patients with severe distress, 57% missed at least one appointment compared with only 18% of those with no, low, or moderate distress (P < .01). In addition, 50% of patients with severe distress scores were admitted to the hospital during their radiation therapy compared with only 11% of patients with no, low, or moderate distress (P < .01).

Researchers also examined the influence of clinical and demographic factors on levels of patient distress. No associations were identified between distress score and weight loss or having a prolonged time between initial consultation and treatment initiation. However, the stage of a patient’s cancer was positively associated with distress (each increase in stage predicted an average increase of 0.8 points on a patient’s distress score [P < .05]).

“Our field has made great advancements in treatments for patients with cancer, but psychosocial factors influence a patient’s ability to receive the appropriate treatment without delay or interruption. Our study demonstrates an association between distress and radiation therapy–specific outcomes, adding to the growing body of evidence emphasizing a need for an interdisciplinary approach to cancer care,” Anderson said.