Editor’s Note: The following column was written by Oncology Psychologist Jeffrey Kendall, PsyD, LP, the director of oncology support care with University of Minnesota Health Cancer Care services.
Guilt, anger, fear of recurrence, a heightened sense of vulnerability, sadness.
If you have cancer—or have a loved one with cancer—you’ve most likely experienced some or all of these emotions at some point during your cancer journey. Sometimes, the psychological distress is so intense that it meets the criteria for a clinical condition, including depression, anxiety, adjustment disorders or post-traumatic stress disorder. These negative emotional states can affect every aspect of a cancer patient’s life—including the cancer treatment itself and treatment outcomes.
To help cancer patients and their loved ones cope with the emotional challenges that often accompany a cancer diagnosis, University of Minnesota Health Cancer Care providers have implemented a verbal screening system to measure a person’s distress before each visit with a cancer specialist.
Our distress screening consists of seven questions that are answered using a zero to 10 scale. The screening covers psychological, social, nutritional and spiritual issues—but takes less than a minute to complete. Anyone who scores high on one of the questions will be contacted after the appointment by a relevant support care professional. During this follow-up conversation, the support care professional may offer assistance and/or set up a time to meet in person.
Why are we implementing a this screening process?
Research increasingly demonstrates that 25 percent to 50 percent of all people with cancer experience levels of distress high enough to disrupt their cancer care and negatively influence all aspects of their daily life. Because so many people are affected, the importance of addressing emotional and social concerns have made distress screening and management a standard of oncology care across the country.
The term “distress” defines unpleasant feelings or experiences that interfere with a person’s ability to effectively cope with a cancer diagnosis, its symptoms, and subsequent treatments. We use this term because:
Distress often varies as a people progress through their cancer journey. Problems may remain for months and years after diagnosis. The intensity of distress may increase with an increase in treatment side effects, increasing pain or disability and cancer recurrence. People with lung, brain, pancreatic and blood cancers are more likely to report elevated distress levels, but differences by cancer type are usually small. In addition, women and people diagnosed under age 50 years often report higher distress than men or individuals over age 50.
We know that visits with a support care professional can help people with cancer reduce their level of distress and greatly improve their quality of life. Not only that, but research demonstrates that access to adequate emotional or psychological support can improve cancer outcomes. Given this knowledge, some have said it is ill considered not to provide these services to cancer patients.