Distress Screening in a Cancer Survivorship Clinic: Impact on Psychosocial Referrals

Head and neck cancer is a life-changing experience. Treatment can be single-modality or multimodality therapy, including surgery, radiation, chemotherapy, or clinical trials. All cancer survivors experience distress, but head and neck cancer survivors are more likely to experience it due to the bodily functions affected by this disease. Distress screening is now a part of routine cancer care at diagnosis, treatment, and pivotal times of the journey. However, in a survivorship clinic in this study, a distress screening tool was not implemented at routine follow-up appointments after completing treatment. Head and neck cancer survivors were followed for cancer surveillance by specialists or primary care providers on a 6- to 12-month basis, where patients could routinely self-report any distress. The purpose of this quality improvement (QI) project was to determine how the use of a distress screening tool over a 12-week period affected referrals for psychosocial needs among head and neck cancer patients who were 2 or more years post-treatment. The sample consisted of head and neck cancer survivors in a survivorship clinic (n = 260). This study found that using the NCCN Distress Thermometer (DT) screening tool to measure distress in survivorship patients significantly (p = .0001) increased the number of referrals for psychosocial needs, with 0 referrals made pre-intervention compared with 12 referrals made post-intervention. Screening for psychosocial distress using the DT screening tool was effective in identifying head and neck cancer survivors in this clinic who were candidates for a referral to address psychosocial needs.