Risk Factors Associated With Distress Among Postoperative Patients in an Academic Gynecologic Oncology Practice

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Maya E. Gross Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI

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Janelle N. Sobecki Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI

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Chan Park Department of Statistics, University of Wisconsin, Madison, WI

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Menggang Yu Department of Biostatistics and Medical Informatics, University of Wisconsin Carbone Cancer Center, Madison, WI

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Sumer K. Wallace Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI

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Background: Distress among gynecologic oncology patients correlates with poor clinical outcomes and decreased quality of life. The purpose of this study was to determine risk factors for elevated NCCN Distress Thermometer (DT) results among postoperative gynecologic oncology patients. Patients and Methods: We performed a retrospective chart review of all postoperative visits over a 5-year period. NCCN DT results were analyzed as both discretized values (DT ≤3 = low distress; DT 4–8 = moderate distress; DT ≥9 = high distress) and continuous variables. Patients with a DT score ≥4 were referred to social work. Univariate and multivariate regression analyses were performed to compare NCCN DT results with clinical and sociodemographic variables. Statistical significance was P<.05. Results: In total, 1,795 NCCN DT results were included, with uterine (37.72%) being the most common disease site. Benign pathology was known prior to completion of the NCCN DT in 13.15% of patients. Most patients (71.75%) endorsed low levels of distress. Moderate/High levels of distress were reported by 28.25% of patients. Increasing levels of distress were significantly associated with younger age (P=.006), history of depression (P≤.001), status as a current smoker (P=.028), and history of asthma (P=.041). Knowledge of benign pathology was associated with low levels of distress (P=.002). Procedure type and disease site were not associated with distress. Conclusions: More than one-fourth of postoperative patients in a gynecologic oncology practice reported moderate or high distress. Distress was highest among those with malignancy regardless of disease site or surgical intervention. Benign pathology correlated with decreased distress. Identified associations with distress provide opportunities for prevention, early intervention, and tailored counseling.

Submitted April 26, 2023; final revision received September 27, 2023; accepted for publication September 27, 2023. Published online February 16, 2024.

Author contributions: Study concept and design: Gross, Wallace. Data curation: Gross. Formal analysis: Gross, Park, Yu, Wallace. Methodology: Park, Yu, Wallace. Supervision: Sobecki. Writing—original draft: Gross. Writing—review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Sumer Wallace, MD, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, H4/664A, Madison, WI 53792. Email: swallace9@wisc.edu
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