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Are needs assessments cost effective in reducing distress among patients with cancer? A randomized controlled trial
William Hollingworth1, Chris Metcalfe, Susana Mancero
1William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom.
Purpose:
Patients with cancer have a high prevalence of distress. We evaluated whether distress monitoring and needs assessment using the Distress Thermometer and Problem List (DT&PL) improved patient outcomes.
Patients And Methods:
We conducted an unblinded, two-arm, parallel randomized controlled trial at two sites among patients starting radiotherapy or chemotherapy. The intervention group completed the DT&PL, rating distress and discussing sources of distress with a trained radiographer/nurse. No specific triage algorithms were followed. The control group received usual care. The main outcome measure was psychological distress (Profile of Mood States [POMS], short form) up to 12 months; secondary outcomes were quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30) and health care costs.
Results:
Of 220 patients randomly assigned, 112 patients were allocated to the DT&PL. Ninety-five percent completed the primary outcome at 12 months. The DT&PL took 25 minutes; one third of patients had high levels of distress, and most reported physical (84%) or emotional (56%) problems. There was no evidence of an effect of the DT&PL on adjusted POMS scores over follow-up (difference between groups, -1.84; 95% CI, -5.69 to 2.01; P = .35) or in secondary outcomes. The DT&PL cost £19 ($28) per patient and did not lower subsequent health care costs. Few patients (< 3%) in either arm of the trial were referred to a clinical psychologist.
Conclusion:
Patients with cancer have a high prevalence of distress. Needs assessment can be performed quickly and inexpensively. However, the DT&PL was not cost effective in improving patient mood states. It is important to explore the reasons for this so that oncology units can design better services to support patients.
