Symptoms of psychological distress, such as depression and anxiety, are common with any cancer but are particularly prevalent with head and neck cancers (HNCs), affecting as many as 35% of patients.1,2 Several factors likely contribute to risk, including posttreatment disfigurement and history of substance abuse.3-7 At-risk patients, however, are often not identified by providers.8-12 Left untreated, distress can contribute to poorer quality of life (QOL) and reduced survival.13-20
The importance of identifying those at risk is reflected in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Distress Management, which recommend that cancer centers incorporate distress screening into routine care (available at NCCN.org).1 For example, NCCN recommends using the validated Distress Thermometer (NCCN-DT), a visual analogue scale that allows patients to rate their perceived level of distress in the last 7 days on a scale of 0 (“no distress”) to 10 (“extreme distress”). Patients clarify the source of distress using a 39-item problem list with 5 categories: practical, family, emotional, spiritual/religious, and physical. A score of 4 or greater suggests heightened distress and is a cue for providers to further assess identified patients and their need for treatment.1
Although distress screening is an integral part of patient-centered cancer care and is included in ASCO's Quality Oncology Practice Initiative (QOPI) measures,1,21-24 few US cancer centers have adopted formalized screening programs for distress.25 In response, a quality improvement (QI) project was developed to improve care through identifying and addressing distress in HNC medical oncology patients. Specifically, a microsystem-based theory was used to apply the available evidence on distress screening to the local setting.26 This work has the potential to inform the planning and implementation of distress screening programs in cancer centers nationally.
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HammerlidESilanderEHornestamL. Health-related quality of life three years after diagnosis of head and neck cancer—a longitudinal study. Head Neck2001;23:113–125.
HowrenMBChristensenAJKarnellLH. Health-related quality of life in head and neck cancer survivors: impact of pretreatment depressive symptoms. Health Psychol2010;29:65–71.
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ASCO's Quality Oncology Practice Initiative. Measures SummarySpring2014. Available at: http://qopi.asco.org/documents/QOPI-Spring-2014-Measures-Summary.pdf. Accessed June 9 2014.
SchenckAPRokoskeFSDurhamDD. The PEACE project: identification of quality measures for hospice and palliative care. J Palliat Med2010;13:1451–1459.
JacobsenPBShibataDSiegelEM. Initial evaluation of quality indicators for psychosocial care of adults with cancer. Cancer Control2009;16:328–334.
American College of Surgeons. Cancer Program Standards 2012 Version 1.2.1: Ensuring Patient-Centered. Available at http://www.facs.org/cancer/coc/programstandards2012.html. Accessed May 30 2014.
FosterTRegan-SmithMMurrayC. Residency education preventive medicine, and population health care improvement: the Dartmouth-Hitchcock leadership preventive medicine approach. Acad Med2008;83:390–398.
NelsonECBataldenPBLazarJS. Improvement: foundations of knowledge for change in health care systems. In: NelsonECBataldenPBLazarJS eds. Practice-Based Learning and Improvement: A Clinical Improvement Action Guide. 2nd edition. Oakbrook Terrace, IL: Joint Commission Resources, Inc; 2007:1–12.
ONS PEP Guidelines/Expert Opinion Table: Depression. Available at: www.ons.org/Research/PEP/media/ons/docs/research/outcomes/depression/guidelines.pdf. Accessed May 30 2014.
Cancer Care Ontario: symptom management tools: algorithms for managing anxiety and depression. Available at: https://www.cancercare.on.ca/toolbox/symptools/. Accessed June 23 2014.
American Cancer Society. Distress in People with Cancer. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002827-pdf.pdf. Accessed May 30 2014.
AdkinsBTitus-HowardTMasseyV. Recognizing depression in cancer outpatients: a quality improvement project. Commun Oncol2005;2:528–533.
DudgeonDKingSHowellD. Cancer Care Ontario's experience with implementation of routine physical and psychological symptom distress screening. Psychooncology2012;21:357–364.
GilbertJEHowellDKingS. Quality improvement in cancer symptom assessment and control: the provincial palliative care integration project (PPCIP). J Pain Symptom Manage2012;43:663–678.