Radiation Therapist Role in Distress Screening for Cancer Patients Brianne Loritz University of Wisconsin La Crosse

Objective To evaluate a radiation therapists’ role in distress screening for cancer patients receiving radiation therapy treatment using distress management guidelines given by the National Comprehensive Cancer Network (NCCN) Radiation therapist responsibility Patient Needs Assessment

Overview Neurologist Candace Pert reports, “health affects emotions.”1 Inflammatory response to cancer treatment elevates levels of cytokines that induce depressive symptoms1 Ie tumor lysis American Cancer Society reports up to one in four people with cancer suffer from clinical depression or distress2 Distress has been found to decrease the survival of cancer patients.3-5,8,9

NCCN Distress Management Implementation Don’t overlook the importance of distress screening < 5% of patients in distress receive psychological treatment3 NCCN standard protocol; patients are screened at initial, mid-tx, and follow-up3,4,8 NCCN distress tools Distress Thermometer (zero-ten) Hopkins Symptom Checklist (HSCL) Patient Health Questionnaire (PHQ)

Barriers3-6 Difficulty communicating personal feelings with strangers Insufficient time and staff Whose responsibility? Therapist, nurse, MD? Expensive Integrative care Training of staff Patients feel supportive care will not benefit

RTOG Study6 Found 16 percent of the 455 patients screened positive for depressive symptoms Used PHQ (2 questions) “Within the last two weeks, have you had little interest or pleasure in doing things?” “Do you feel down, depressed or hopeless?” Easy 2 questionnaire, hopes to prompt therapist to screen every patient

Patient response7 “this screening tool gives the opportunity to discuss problems without having to ‘put myself out there,’ the opportunity comes to the patient rather than the patient having to seek it out which they may not.”7 “it helps you to vocalize some of the things going on in your body and elsewhere and find out what resources there are in the community. I often think ‘no, I’m alright’ rather than going and seeking assistance.”7

Recognizing Emotional Distress Patients may develop signs of distress over time9 Patients avoid discussing emotions and personal well-being9 Can recognize distress through self-esteem issues, spiritual worries, or physical burdens9 Different perception of distress by therapists

Increased Vulnerability 3,4,8 Instances include: Awaiting treatment Transition to survivorship Recurrence/progression of disease During work-up End of life

Benefits Increased patient satisfaction Better patient-caretaker relationship Overall better patient care for physical and mental well-being Impact the quality of life for patients

Conclusion3-5,7-8 Appropriate time should be dedicated to distress screening7 Necessary training for staff3 Patient education should be separate from distress screening3-5 Distress management = “sixth vital sign” 8 NCCN goal: distress screening develops to the standard of oncology care.3-5,7

References 1. Vital Spark. Naturotherapy. http://www.mcs.ca/vitalspark/2040_therapies/514natu.html. 2011. Accessed February 4th 2014. 2. American Cancer Society. Depression. http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/dealingwithsymptomsathome/caring-for-the- patient-with-cancer-at-home-depression. 2013. Accessed January 28th 2014. 3. Fulcher CD, Gosselin-Acomb TK. Distress Assessment: Practice Change Through Guideline Implementation. Clinical Journal of Oncology Nursing. 2007;11(6). doi: 10.118888/07.CJON.817-821 4. Holland JC, Jacobsen PB, Steensma DP. Caring for the Whole Patient: The Science of Psychosocial Care. Journal of Clinical Oncology. 2012;30(11):1151-1153. doi: 10.1200/JCO.2011.41.4078 5. Wagner LI, Spiegel D, Pearman, T. Using the Science of Psychosocial Care to Implement the New American College of Surgeons Commission on Cancer Distress Screening Standard. Journal of the National Comprehensive Cancer Network. 2013;11(2):214-221. pmid: 23411387 6. American Society for Radiation Oncology. Two-Item Questionnaire Proves to be a Valid Depression Screening Tool for Radiation Therapy Patients. ASTRO News & Media. https://www.astro.org/News-and-Media/News-Releases/2013/Two-item- questionnaire-proves-to-be-a-valid-depression-screening.aspx. 2013. Accessed January 28th 2014. 7. Jones R, Regan M, Ristevski E, Breen S. Patients’ Perception of Communication with Clinicians During Screening and Discussion of Cancer Supportive Care Needs. Patient Education and Counseling. 2011;85(3):209-215. http://libweb.uwlax.edu:2113/science/article/pii/S0738399110007457 8. Gist Cancer Research. NCCN Guideline for Distress Management. http://www.gistinfo.org/gist-information/nccn-guidline- for-distress-managment/. 2013. Accessed January 28th 2014. 9. Chaturvedi SK. Psychiatric Oncology: Cancer in Mind. Indian Journal of Psychiatry. 2012;54(2):111-118. doi: 10.4103/0019- 5545.99529. 10. Jacobsen PB, Wagner, LI. A New Quality Standard: The Integration of Psychosocial Care Into Routine Cancer Care. Journal of Clinical Oncology. 2012;30(11):1154-1159. doi: 10.1200/JCO.2011.39.5046. 11. Lopez-Sendin N, Alburquerque-Sendin, F, Cleand JA, et al. Effects of Physical Therapy on Pain and Mood in Patients with Terminal Cancer. The Journal of Alternative and Complementary Medicine. 2012;18(5):480-486. doi: 10.1089/acm.2011.0277