HSR20-082: Use of the NCCN Distress Thermometer to Identify and Address Distress During a Telemedicine Visit With Rural Head and Neck Cancer Survivors

Rural cancer patients who travel to receive treatment from a large or regional cancer center may take advantage of supportive care services during treatment, but once they no longer regularly travel to the care site, they struggle to access supportive services. To address unmet cancer survivorship needs in the rural population, we developed and conducted a feasibility study evaluating a nurse-led telemedicine videoconferencing intervention aimed at the head and neck cancer (HNC) survivor population. HNC survivors have the second highest suicide rate of all cancers, several times higher than that of the general population. This disparity may be due to the impact of treatment on areas of the body imperative for critical activities such as speech and swallowing, and loss of facial integrity, all of which may worsen psychosocial outcomes and decrease quality of life. We recruited 16 HNC survivors during their end of treatment (EOT) visit at an NCI-designated cancer center in Central Virginia serving a rural catchment area, to participate in a nurse-led telemedicine intervention. The visit was conducted 6 weeks following the EOT visit. Survivors participated in the visit either from their home or at one of 96 telemedicine sites across Virginia. Over a HIPAA-secure videoconference call, a cancer practice-based registered nurse assessed the patient using the NCCN Distress Thermometer (DT), amended for the HNC population to include issues such as jaw swelling and speech difficulties. The nurse identified areas of distress, then led patients in a discussion to elucidate specific concerns. Using therapeutic communication, the nurse investigated sources of distress and offered targeted survivorship care education and supportive care referrals. Of the 16 participants, the most common issues identified were fatigue (69%), worry (63%), family health issues (56%) and hearing loss (56%). Although only 3 participants identified jaw swelling as an issue, this was the most highly rated area of distress on the DT (7/10). Participants were successfully referred to speech language pathologists, lymphedema specialists, and social workers, although of the 6 participants offered a social work referral, 5 declined. A nurse-led telemedicine visit using the NCCN DT appears to be a feasible modality for evaluating and providing referrals for physical distress in a rural HNC survivorship population, and may impact psychosocial distress.

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Corresponding Author: Pam Baker DeGuzman, PhD
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