Initiation of distress screening in oral cancer clinics in Sri Lanka

Abstract

Objective: This paper describes the initiation of distress screening in oral cancer clinics, among patients with oral cancer in Sri Lanka, addressing the service gap of lack of psychosocial oncology services. This involved validation of the Sinhala version of the Distress Thermometer (DT) and Problem List (PL) as an adjustment disorder (AD) screening tool. Methods:The DT and PL were translated into the Sinhala language and crossculturally adopted by the "modified Delphi" technique. The judgment validity was obtained through face, content, and consensual validation. The criterion validation of DT was performed among 95 oral cancer patients from two oro-maxillofacialoncological hospitals in Sri Lanka, against the AD diagnosis of two consultant psychiatrists. Results:The DT and the PL revealed good judgment validity. The optimal cut-off point of DT was 4 with a sensitivity of 91.8% (95% CI = 80.8%-96.8%), specificity of 78.3% (95% CI = 64.4%-87.7%), positive predictive value of 0.81 (95% CI = 0.53%-1.1%) and negative predictive value of 0.90 (95% CI = 0.2%-1.7%). The test re-test reliability of DT was excellent (Kappa coefficient 0.894). The area under the curve was 0.843. The PL demonstrated poor internal consistency in practical problems (KD-20 = 0.4), social problems (KD-20 = 0.3) and spiritual problems (KD-20 = 0.6). Conclusions:The Sinhala version of DT and PL were deemed a valid AD screening tool for patients with oral cancer in Sri Lanka to initiate distress screening in busy oral cancer clinics. However, further validation for the full spectrum of distress is needed, preferably with improvements to PL.

Prevalence and associated factors of psychological distress among patients with oral cancer in Sri Lanka

“…There are no studies purely on the prevalence of psychological distress among patients with oral cancer in Sri Lanka. Of the available few studies among patients with other types of cancers, Mudduwa in 2011 reported a prevalence of 30.66% among patients with breast cancer which was similar to the present study finding 40 . However, in this study, the final diagnosis was made by the Consultant Psychiatrist whereas the current study used the Sinhala-validated Distress Thermometer.…”

“…The sample size for the prevalence study was calculated with a Z value of 1.96 at a 95% confidence interval and 0.05 precision. The anticipated prevalence of psychological distress among patients with oral cancer was 30.7% 40 , and for a 10% non-response rate, the sample size for the prevalence study was 355 41 . For the unmatched case-control study the highest sample size gained for the estimated odds ratio of the associated factors was 65 per arm after adjusting for a non-response rate of 5% 42 .…”

“…There is limited research on psychological distress among patients with cancer in Sri Lanka. Using the General Health Questionnaire-12 as an assessment tool, a prevalence of 69% was evident among patients with oral cancer 39 , while a prevalence of 30.66% was shown among patients with breast cancer 40 . To the best of the author's knowledge, no studies have been undertaken to identify the associated factors of psychological distress among patients with oral cancer in Sri Lanka.…”

An overview of the burden of oral cancer in Sri Lanka and its inequalities in the face of contemporary economic and social malaise

“…Therefore, screening for distress and providing psychosocial supportive care has to be an integral component of quality cancer care 54 . As Sri Lanka has lacked this aspect, initiation of distress screening in oral cancer clinics was introduced 55 . Furthermore, an intervention package introducing psychosocial supportive care was trialled using the existing cadre of public health nursing officer a category of hospital‐ and community‐based health workers with some success 56 …”

“…54 As Sri Lanka has lacked this aspect, initiation of distress screening in oral cancer clinics was introduced. 55 Furthermore, an intervention package introducing psychosocial supportive care was trialled using the existing cadre of public health nursing officer a category of hospitaland community-based health workers with some success. 56 Most oral cancer patients are treated by primary surgical resection and this is done across the nation in accordance with the National Guidelines which, in turn, closely mirror international best practice.…”