title: Implementing routine screening for distress, the sixth vital sign, for patients with head and neck and neurologic cancers.
abstract: This study examined the benefits of incorporating screening for distress as a routine part of care for patients with head and neck and neurologic cancers in a tertiary cancer center. Using a comparative 2-cohort pre-post implementation sequential design, consecutive outpatients with head and neck and neurologic cancers were recruited into 2 separate cohorts. Cohort 1 included patients attending clinics during April 2010, before the implementation of the screening program. The program was then implemented and patients completed the Screening for Distress Minimum Dataset (the Edmonton Symptom Assessment System [ESAS] and the Canadian Problem Checklist [CPC]) at each clinic visit. Cohort 2 included patients attending clinics during March 2011. Consenting patients completed screening and outcome measures (ESAS, CPC, and either the Functional Assessment of Cancer Therapy-Brain or the Functional Assessment of Cancer Therapy-Head and Neck). A total of 146 patients (78 head and neck and 68 neurologic) provided data for Cohort 1, and 143 (81 head and neck and 62 neurologic) provided data for Cohort 2. Compared with Cohort 1, patients with neurologic cancers in Cohort 2 reported significantly higher scores on the Functional Assessment of Cancer Therapy: General total and emotional quality of life subscale; fewer high scores (≥ 4) on the ESAS breathlessness item; and fewer problems with fears/worries, frustration/anger, finding meaning in life, and worry about friends/family. Head and neck patients in Cohort 2 reported significantly higher emotional quality of life and fewer problems with eating and weight than those in Cohort 1. Although no definitive causal attributions can be made, patients exposed to routine screening for distress reported better well-being and fewer emotional, physical, and practical problems than historical controls.
authors.affiliation: From the aDepartment of Psychosocial Resources, Tom Baker Cancer Centre; bDepartment of Oncology, University of Calgary; cResearch and Evaluation Unit, Alberta Health Services, University of Calgary; and dDepartment of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary Alberta; and the eDepartment of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Bultz
authors.forename: Amy
authors.initials: A
authors.lastname: Waller
authors.forename: Jodi
authors.initials: J
authors.lastname: Cullum
authors.forename: Paula
authors.initials: P
authors.lastname: Jones
authors.forename: Johan
authors.initials: J
authors.lastname: Halland
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Groff
authors.forename: Catriona
authors.initials: C
authors.lastname: Leckie
authors.forename: Lisa
authors.initials: L
authors.lastname: Shirt
authors.forename: Scott
authors.initials: S
authors.lastname: Blanchard
authors.forename: Harold
authors.initials: H
authors.lastname: Lau
authors.forename: Jacob
authors.initials: J
authors.lastname: Easaw
authors.forename: Konrad
authors.initials: K
authors.lastname: Fassbender
authors.forename: Linda E
authors.initials: LE
authors.lastname: Carlson
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009423:Nervous System Neoplasms / Q000150:complications*; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology*