Identifying and Addressing Distress in Cancer Care: A Study of Screening Outcomes and Referrals in Australian...

Psychological distress is highly prevalent among oncology patients and represents an important unmet supportive care need. Yet referrals made following routine distress screening remain poorly understood. This study examined referrals following routine distress screening in outpatient oncology to assess how screening supports patient care, especially for psychological concerns.

All outpatient medical oncology distress screenings at a major metropolitan Victorian hospital from 1 December 2023 to 31 May 2024 were extracted from medical records. Screening was conducted with the NCCN distress thermometer (DT), problem list and additional custom items. Patient characteristics, screening uptake, and referral following screening were analysed.

Of 850 distress screening encounters offered to 773 patients, 82 (9.6%) were declined, leaving 768 completed screening encounters. Among respondents, 53.6% reported clinically significant distress (DT ≥ 4) and 60.4% reported psychological concerns. 35.8% (n = 275) of screenings resulted in at least one referral. Patients with more distress and greater patient-reported need for support were more likely to be referred (both p < 0.001). However, only a small proportion of referrals following screening targeted psychological concerns directly, with just five directed to specialist mental health services.

Distress and psychological concerns are highly prevalent in outpatient oncology, yet referral following screening often does not align with concerns reported. Most referrals are made to external services, limiting integration with oncology care. Improving referral pathways and enhancing access to mental health services within oncology settings are critical steps towards better meeting patients' psychological needs and ensuring that distress screening translates into meaningful, patient-centred care.