Disparities in Psychosocial Distress Screening and Management of Lung and Ovarian Cancer Survivors

Abstract

PURPOSE: Since 2016, the American College of Surgeons' Commission on Cancer (CoC) has required routine distress screening (DS) of cancer survivors treated in their accredited facilities to facilitate early identification of survivors with psychosocial concerns. Lung and ovarian cancer survivors have relatively low 5-year survival rates and may experience high levels of distress. We examined the extent to which ovarian and lung cancer survivors received CoC-mandated DS and whether DS disparities exist on the basis of diagnosis, sociodemographic factors, or facility geography (urban/rural). METHODS: This study included a quantitative review of DS documentation and follow-up services provided using existing electronic health records (EHRs). We worked with 21 CoC-accredited facilities across the United States and examined EHRs of 2,258 survivors from these facilities (1,618 lung cancer survivors and 640 ovarian cancer survivors) diagnosed in 2016 or 2017. RESULTS: Documentation of DS was found in half (54.8%) of the EHRs reviewed. Disparities existed across race/ethnicity, cancer type and stage, and facility characteristics. Hispanic/Latino and Asian/Pacific Islander survivors were screened at lower percentages than other survivors. Patients with ovarian cancer, those diagnosed at earlier stages, and survivors in urban facilities had relatively low percentages of DS. Non-Hispanic Black survivors were more likely than non-Hispanic White survivors to decline further psychosocial services. CONCLUSION: Despite the mandate for routine DS in CoC-accredited oncology programs, gaps remain in how many and which survivors are screened for distress. Improvements in DS processes to enhance access to DS and appropriate psychosocial care could benefit cancer survivors. Collaboration with CoC during this study led to improvement of their processes for collecting DS data for measuring standard adherence.

Incidence, Timing, and Factors Associated With Suicide Among Patients Undergoing Surgery for Cancer in the US

“…While screening for distress is recommended for all patients with cancer by major medical professional societies, 16,17 and is mandated by the American College of Surgeons Commission on Cancer, overall adherence to these recommendations has been shown to be low. [40][41][42][43] Moreover, efforts to implement psychosocial distress screening in clinical practice have largely focused on the integration of psychosocial distress screening in medical oncology practices 42 and not surgical oncology practices. Many patients with cancer who undergo surgical treatment receive their primary cancer care through their surgeon, and many do not ever see a medical oncologist.…”

“…The findings of this study suggest that suicide is an important risk following cancer surgery and highlight the importance of improving access to support groups and implementing regular screening for distress during the postoperative period. While screening for distress is recommended for all patients with cancer by major medical professional societies, and is mandated by the American College of Surgeons Commission on Cancer, overall adherence to these recommendations has been shown to be low . Moreover, efforts to implement psychosocial distress screening in clinical practice have largely focused on the integration of psychosocial distress screening in medical oncology practices and not surgical oncology practices.…”

Addressing Suicidal Ideation in Patients With Cancer: Recommendations for the Oncology Clinician on How to Optimize Routine Screening in the Outpatient Setting

“…However, psychosocial distress, including suicide, remains under-recognized by many oncology clinicians in both community and academic settings. [8][9][10][11] Clinicians support the use of validated assessments and may feel unprepared to inquire about suicidal ideation and be unaware of associated risk factors, for example, male sex, elderly, depression, hopelessness, and previous attempts warranting triage and intervention. [1][2][3][4]8,9 Others note that they lack both access to adequate brief measures and time to conduct lengthy assessment in busy clinical environments.…”

“…[8][9][10][11] Clinicians support the use of validated assessments and may feel unprepared to inquire about suicidal ideation and be unaware of associated risk factors, for example, male sex, elderly, depression, hopelessness, and previous attempts warranting triage and intervention. [1][2][3][4]8,9 Others note that they lack both access to adequate brief measures and time to conduct lengthy assessment in busy clinical environments. 10,11 Empirical data on the impact of the implementation of routine suicide assessment programs within the oncology care outpatient setting remain lacking, including data detailing both the barriers and facilitators for optimal implementation.…”