Distress Screening Scores of Malignant and Benign Hematology Patients: Results of a Pilot Project.

Abstract

3173 The Cleveland Clinic Taussig Cancer Institute completed a pilot project on distress screening as part of the plan to address the American College of Surgeons Commission on Cancer requirement (Standard 3.2: Psychosocial Distress Screening) to screen malignant and benign hematology patients for distress and psychosocial health needs. Over a two week period every hematology patient seeing a physician or mid-level provider completed the distress screening instrument Emotions Thermometer (ET), a five dimensional tool that includes four predictor domains: distress, anxiety, depression, anger and one outcome domain of need for help. Each domain is rated on a 0 to 10 Likert type scale, in a thermometer format. With respect to validity and reliability, the sensitivity and specificity of the ET tool has been found comparable to known validity and reliability of other accepted measures of distress, depression, and anxiety (Mitchell, et al, 2009). Per National Comprehensive Cancer Network (NCCN) guidelines, a score of 4 or higher on distress screening warrants a referral to a psychosocial professional. Distress scores 4 and over were compared among the diagnoses using the Chi-Square test. When the overall P-value was significant (P <0.05), at least two groups differed, and pairwise comparisons were conducted to determine which diagnostic groups differed. Of the five thermometer domains, patients scored highest on anxiety. There were no differences among diagnoses on anger (P=0.51), but there were differences in the other four domains (P<0.001 distress, depression, and need for help; P=0.026 anxiety). For all four, pairwise comparisons indicated that multiple myeloma patients had higher (worse) scores on anxiety, distress, depression, and need for help than all other diagnoses; there were no differences among benign hematology, leukemia/MDS/CML, or lymphoma/CLL. While this pilot project does not answer why multiple myeloma patients report levels of psychosocial distress significantly higher than other hematology patients, increased attention needs to be given to address these patients' experience of anxiety, depression, and distress. This project provides valuable information about the levels of distress experienced among all hematology patients and is useful for determining staffing levels of psychosocial professionals needed to address distress. Percentage of Emotion Thermometer Scores Over 4 Diagnosis Distress Anxiety Depression Anger Help Benign Hem 18% 27% 18% 12% 7% Leuk/MDS/CML 19% 28% 17% 9% 14% Lymph/CLL 18% 31% 16% 14% 13% Myeloma 38% 44% 35% 15% 27% P-value <0.001 0.026 <0.001 0.51 <0.001 Disclosures: No relevant conflicts of interest to declare.

Computational Model of Progression to Multiple Myeloma Identifies Optimum Screening Strategies

“…Patients with MGUS may experience psychological distress similar to that experienced by those with MM, and the identification of cancer precursor states must be accompanied by a discussion of the utility of follow-up in individual patients. 38-42 Promising efforts that evaluate MGUS screening and continuous follow-up before clinical manifestation of MM are under way in a long-term, prospective, three-armed randomized trial (iStopMM). 43 Such long-term efforts highlight the utility of predictive tools such as the one developed here.…”

The Role of a Monoclonal Gammopathy of Undetermined Significance Diagnosis in Healthcare Utilization

“…Patients may experience high distress after a diagnosis of premalignant MGUS. [35][36][37] This associated anxiety could result in a change (overutilization/underutilization) in healthcare utilization and clinical surveillance beyond what is necessary. 38 Quantifying the care and surveillance of patients with MGUS is of clinical relevance given that multiple myeloma patients with a pre-existing MGUS diagnosis have been shown to have a better multiple myeloma prognosis.…”

“…22,53,38 Despite the relatively low risk of progression, patients with a diagnosis of MGUS are generally followed up every 6-12 months for signs of progression to malignancy. [35][36][37] It is not currently possible to predict which patients with MGUS are more likely to progress to multiple myeloma. 54 Elevated monoclonal (M)-protein concentration, 38 immunoglobulin M or A isotype, 38 abnormal bone marrow plasma cells 55,56 and abnormal free light chain ratios are risk factors for progression of MGUS to multiple myeloma.…”

“…24,45,52 Patients with MGUS progress to multiple myeloma at a rate of approximately 1% annually, 22,38,53 yet despite the relatively low risk of progression, patients with MGUS are regularly followed up for signs of progression every 6-12 months. [35][36][37] There are no screening programs available for MGUS detection, primarily due to a lack of treatment for MGUS and the relatively low probability of subsequent development of multiple myeloma. 22,53,38 Understandably, patients may experience high levels of stress after a diagnosis of MGUS, [35][36][37] which could result in changes in healthcare services utilization.…”

Multi‐trajectory models of serum biomarkers among patients with monoclonal gammopathy of undetermined significance

“…Patients with MGUS progress to MM at a rate of approximately 1% annually 15‐17 . Despite the relatively low risk of progression, patients with a diagnosis of MGUS are generally followed with testing every 6–12 months for signs of progression to malignancy 18‐20 …”