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Optimal Frequency of Psychosocial Distress Screening in Radiation Oncology
Clayton B Hess1, Maria Singer2, Aliasgher Khaku2
1Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA chess@ucdavis.edu.
Purpose:
To accurately hypothesize the optimal frequency of psychosocial distress screening in patients undergoing radiation therapy using exploratory modeling of prospective data.
Materials And Methods:
Between October 2010 and May 2011, 71 RT patients underwent daily screening with the Distress Thermometer. Prevalences of Distress Thermometer scores ≥ 4 were recorded. Optimal screening frequency was evaluated by planned post hoc comparison of prevalence rates and required screening events estimated by numerical modeling, consisting of data point omission to mimic weekly, every-other-week, monthly, and one-time screening intervals. Dependence on clinical variables and chronologic trends were assessed as secondary end points.
Results:
A total of 2,028 daily screening events identified that 37% of patients reported distress at least once during the course of treatment. Weekly, every-other-week, monthly, and one-time screening models estimated distress prevalences of 32%, 31%, 23%, and 17%, respectively, but required only 21%, 12%, 7%, and 4% of the assessments required for daily screening. No clinical parameter significantly predicted distress in univariable analysis, but "alone" living situation trended toward significance (P = .06). Physician-reported grade 3 toxicity predicted distress with 98% specificity, but only 19% sensitivity.
Conclusion:
Thirty-seven percent of radiation oncology patients reported distress at least once during treatment. Screening at every-other-week intervals optimized efficiency and frequency, identifying nearly 90% of distressed patients with 12% of the screening events compared with daily screening.
