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Problem-Related Distress in Cancer Patients Drives Requests for Help: A Prospective Study

Problem-Related Distress in Cancer Patients Drives Requests for Help: A Prospective Study

The Moores UCSD Cancer Center has implemented the use of an innovative instrument for screening cancer patients at first visit to assist them with distress due to cancer-related problems. This 36-question screening instrument addresses physical, practical, social, psychological and spiritual problems. Patients are asked to rate the severity of each problem on a scale of 1 to 5, and to circle "Yes" if they would like staff assistance. Data from a prospective study of the first 2,071 patients to complete this questionnaire has been entered into a database and analyzed to identify common patient problems, demographics, and trends. The five most common causes of problem-related distress were fatigue, sleeping, finances, pain, and controlling my fear and worry about the future. The five most common problems for which patients circled "Yes" to ask for assistance were understanding my treatment options, fatigue, sleeping, pain, and finances. Compared to the entire population, patients who circled "Yes" on a particular problem, demonstrated a robust increase in problem-related distress.

Not surprisingly, cancer patients experience unique life problems and high levels of distress throughout the diagnosis and treatment process, yet this phenomenon has been acknowledged only in the past 25 years.[1] The National Comprehensive Cancer Network (NCCN) recommends distress screening for cancer patients,[2] and the literature supports the use of distress screening to address problems before a crisis necessitates intervention.[3-5]

From the July 2005 opening of the Moores UCSD Cancer Center, a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, all patients have been screened for problem-based distress at first visit. Based on 10 years of experience in cancer problem–related distress screening,[6] we have developed a biopsychosocial screening instrument titled How Can We Help You and Your Family? (see Figure 1). For clinical purposes, individual screening data have been used to refer distressed patients for supportive care within the Science of Caring team. For research purposes, screening data have been entered into a database for analysis to identify common problems and trends. Using this information, we have developed and continue to modify our educational and intervention programs in a way that is tailored to the needs of our patient population.

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