HSR20-100: Results From a Pilot Study Examining the Impact of Distress Screening and Referral on Cancer Patient Cost and Health Care Utilization

Background: The Cancer Support Community (CSC) has investigated screening, referral and follow-up for cancer-related distress through the CancerSupportSource® (CSS) since 2008. The impact of CSS on patient cost and health care utilization at a community cancer center was explored. Methods: 482 breast cancer (BC) patients who completed CSS screening from 1/2016 to 6/2017 were classified into those who utilized CSC supportive services within one year following screening (screened and acted, SA; n =38) and those who did not; matched to SA 2:1 on age, diagnosis, and CSS referral needs (screened only, SO; n =76). Patients scheduled for screening but not screened were matched to SA 1:1 on age and diagnosis (never screened, NS; n =38). Total billable charges across 2 years from screening, or date of scheduled screening, for emergency department (ED) and office and outpatient services were extracted. Ordered logistic regression to model categories of cost for ED services and outpatient services and logistic regression to model ED visit (Y/N), outpatient visit (Y/N), and hospital inpatient stay (Y/N) were completed (adjusted for race, ethnicity, and age). Results: Participants were on average 56 years old; 15% Latino. Race differed across screening groups: 8% Black among NS; 9% among SO; 29% among SA ( p =.018). 59% were screened within one month of diagnosis. Total 2-year cost/patient for ED services ranged from $0-$703,000; outpatient services $0-$274,000. Median 2-year cost/patient for ED and outpatient services combined was: NS=$995; SO=$1170; and SA=$1360 (Kruskal-Wallis test, p =0.87). Per regression analysis, conditional probability for being in the highest category of ED cost (>$35,000 across 2 years) was 10% for NS, 8% for SO, and 8% for SA, and of being in the highest category of outpatient cost (>$1800) was 13%, 17%, and 19%, respectively. The conditional probability of having an ED visit was 39% for NS, 35% for SO, and 30% for SA with marginal effects of 0.04 ( SE =0.09, p =0.66) and 0.09 ( SE =0.11, p =0.38), respectively. Conclusion: This pilot study suggests we could expect a 4-percentage point decrease in the proportion of respondents who visit the ED in 2 years following screening and a 9-percentage point decrease if the patient is screened and used CSC resources. Distress screening and action could potentially limit ED visits and costs and hospital stays but should be tested in a larger prospective study.

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Corresponding Author: Melissa F. Miller, PhD, MPH
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