Distress and Care Utilization in Patients with Myeloproliferative Neoplasms

Distress negatively affects cancer outcomes. The National Comprehensive Cancer Network (NCCN) recommends screening patients for distress by a self-reported scale (0-10) and referring those with scores ≥4 to supportive services (SSs). Little is known about the prevalence of distress and healthcare utilization in classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs): polycythemia vera (PV), essential thrombocythemia (ET), myelofibrosis (MF).

We retrospectively identified MPN patients at our center to measure the proportions of patients with distress ≥4 evaluated by a SS (chaplaincy, integrative oncology, palliative medicine, psychiatry, psychology, and social work [SW]) or had acute care utilization (ACU; ≥ 1 ED visit or hospitalization) within 6 months of electronic distress screening (EDS). We also obtained sociodemographic, disease characteristics, and symptom score data to stratify variables associated with distress.

Among 141 patients (44 PV, 49 ET, and 48 MF), the median age was 63 years (range, 25-89). Most patients identified as female (62%), white (77%), and completed EDS within 3 months of diagnosis (55%). Of 75/141 (53%) who reported distress ≥4, only 25/75 (33%) were evaluated by SS, and 23/75 (31%) had ACU within 6 months of EDS. Patients with distress ≥4 evaluated by SS had significantly higher ACU (48% vs. 14%; p = 0.009). Distress was associated with higher symptom scores and more ED visits but not gender, race, ethnicity, diagnosis, relationship status, or insurance.

Despite consensus recommendations, most patients with distress ≥4 were not evaluated by SS. Future work should identify ways to better use patient-reported outcomes to promote early intervention.