Elsevier

Oral Oncology

Volume 45, Issue 10, October 2009, Pages e129-e133
Oral Oncology

Computerized prospective screening for high levels of emotional distress in head and neck cancer patients and referral rate to psychosocial care

https://doi.org/10.1016/j.oraloncology.2009.01.012Get rights and content

Summary

To investigate prospectively the prevalence of high levels of emotional distress and referral rate to psychosocial care in head and neck cancer (HNSCC) patients. Fifty-five consecutive newly diagnosed HNSCC patients were asked to complete the hospital anxiety and depression scale (HADS) and the EORTC QLQ-C30 and H&N35 quality of life questionnaires on a touch screen computer-assisted data collection system on their first visit and during follow-up visit. Sociodemographic, clinical, and quality of life parameters were compared to a high level of distress (HADS score >15). Number of patients with a high level of distress were compared to referral rates to psychosocial care as retrieved from patient hospital files. At time of diagnosis, 18% (10/55) of the patients had a high level of distress (related to tumor stage and site, and global quality of life and social eating) versus 25% (14/55) at follow-up (related to a variety of quality of life parameters). Low levels of distress at baseline or follow-up was noted in 64%; 18% had normal scores at baseline and developed distress at follow-up; 11% had high levels at baseline and returned to normal scores at follow-up, and 7% had persistent distress from baseline to follow-up. No patients were referred to psychosocial care at time of diagnosis. At follow-up visit 21% (3/14) were referred, all patients who developed a high level of distress after initial diagnosis. High level of emotional distress is common and few patients are referred to psychosocial care. Development of a stepped care model (including careful monitoring by using a touch screen computer system) may meet the potentially unmet needs of HNC patients and contribute improving cancer care.

Introduction

Head and neck squamous cell carcinoma (HNSCC) patients often have to deal with side-effects of treatment, such as pain, fatigue, dry mouth, and speech and swallowing problems, negatively affect health-related quality of life (HRQOL).1 Emotional distress is also common.[2], [3], [4], [5], [6], [7] During the first year after treatment there is a gradual improvement of emotional functioning,[8], [9], [10] but many patients continue to suffer from or develop distress[11], [12], [13] and it is estimated that almost 30% suffer from distress.14 In cancer care, emotional distress is argued to be the sixth vital sign (besides temperature, respiration, heart rate, blood pressure, and pain) as a marker of health and well-being and as a target outcome measure.15 A recent study revealed that support groups, psycho-education and cognitive behavioral psychotherapy may be effective to improve emotional distress.16 Because the number of patients living with cancer is expected to increase dramatically due to the ageing population and improved (early) diagnostics and treatment, the need for psychosocial intervention will increase accordingly. However, in clinical practice heightened distress often goes unrecognized by oncological care professionals, especially those working in the field of head and neck cancer.17 As a result there are high levels of untreated distress in cancer patients.18 Implementation of efficient screening techniques becomes essential in clinical practice to enable adequate referral to psychosocial care. Information on referral rates in HNSCC cancer patients is lacking. The goals of the present study are: (1) to assess prospectively the prevalence of a high level of emotional distress in HNSCC patients as assessed by a newly developed touch screen computer-assisted system, (2) to investigate the factors that contribute to a high level of distress at baseline and after treatment, and (3) to assess current referral rates to psychosocial care. Results will contribute to better insight into the feasibility of screening distress in clinical practice and possibly unmet needs for psychosocial care.

Section snippets

Patients

From May 2006 to June 2007, 55 consecutive newly diagnosed HNSCC patients were asked to participate. The inclusion criterium was curative treatment for HNSCC. Exclusion criteria were: diseases causing cognitive dysfunction and poor understanding of the Dutch language. Age, gender, comorbidity, tumor site and stage, and treatment modality were recorded. Comorbidity was assessed with the Adult Comorbidity Evaluation 27 (ACE-27). The ACE-27 was designed specifically for cancer patients and

Patients

The patient group consisted of 38 males and 17 females (mean age 63 years (range 42–86)). Comorbidity (stage 0) was absent in 27 patients, 23 patients were classified in stage 1 (mild), 4 patients in stage 2 (moderate), and 1 patient in stage 3 (severe) (this patient was added to stage 2 for statistical analyses). Tumor site included larynx/hypopharynx (n = 22), oral/oropharynx cancer (n = 18), nasopharynx (n = 5), parotid glands (n = 2) and other (n = 8) (the last three categories were combined for

Discussion

Prospective screening for emotional distress via a touch screen computer system revealed that 18% of the patients had a high level of distress at time of diagnosis versus 25% after treatment. This is comparable with previous data on prevalence of distress in HNSCC patients as assessed by a conventional pen and paper method14, indicating that routine screening for distress via a touch screen computer system is feasible and reliable. Other studies also found that computer based HRQOL

Conflict of Interest Statement

None declared.

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