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

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. References
1. Vital Spark. Naturotherapy Accessed February 4th 2014.
2. American Cancer Society. Depression. patient-with-cancer-at-home-depression 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: /07.CJON
4. Holland JC, Jacobsen PB, Steensma DP. Caring for the Whole Patient: The Science of Psychosocial Care. Journal of Clinical Oncology. 2012;30(11): doi: /JCO
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 ;11(2): pmid:
6. American Society for Radiation Oncology. Two-Item Questionnaire Proves to be a Valid Depression Screening Tool for Radiation Therapy Patients. ASTRO News & Media. questionnaire-proves-to-be-a-valid-depression-screening.aspx 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):
8. Gist Cancer Research. NCCN Guideline for Distress Management. for-distress-managment/ Accessed January 28th 2014.
9. Chaturvedi SK. Psychiatric Oncology: Cancer in Mind. Indian Journal of Psychiatry. 2012;54(2): doi: /
10. Jacobsen PB, Wagner, LI. A New Quality Standard: The Integration of Psychosocial Care Into Routine Cancer Care. Journal of Clinical Oncology ;30(11): doi: /JCO
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): doi: /acm