Transcript Radiation Therapist Role in Distress Screening for Cancer Patients

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)
3-6
Barriers
• 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
6
Study
• 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
• Instances include:
•
•
•
•
•
Awaiting treatment
Transition to survivorship
Recurrence/progression of disease
During work-up
End of life
3,4,8
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
3-5,7-8
Conclusion
• 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-thepatient-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
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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-itemquestionnaire-proves-to-be-a-valid-depression-screening.aspx. 2013. Accessed January 28th 2014.
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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
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8. Gist Cancer Research. NCCN Guideline for Distress Management. http://www.gistinfo.org/gist-information/nccn-guidlinefor-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: 10.4103/00195545.99529.
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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.
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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