There was more than a threefold increase in the number of provinces reporting province-wide implementation of standardized screening for distress tools in cancer centres from 2007 to 2015.
The extent to which provincial cancer agencies and programs have implemented standardized tools to screen for distress as of 2015. The results are reported by province.
The 2009 Cancer System Performance Report.
Why measure this?
In people with cancer, distress is generally defined as an unpleasant emotional experience or experiences. It is related to psychological, social, spiritual, practical or physical concerns that may negatively affect a person’s ability to cope with cancer and its treatment.1 Late identification of distress in cancer patients has been associated with negative outcomes, including poorer adherence to treatment recommendations, lower levels of satisfaction with care and poorer self-reported quality of life.2-5 Screening for distress at various points in the patient journey can be useful in customizing interventions that address patients’ changing needs, which may improve quality of life.
What are the key findings?
- In 2015, seven of the 10 reporting provinces had implemented province-wide, provincially coordinated, standardized screening for distress tools in cancer centres, with findings reported centrally (Table 5.1). In 2007, only two provinces reported province-wide implementation (data not shown).
- In 2014, Newfoundland and Labrador had not implemented provincially coordinated, standardized screening for distress (data not shown). In 2015, however, the province had partially implemented standardized screening for distress that is provincially coordinated (Table 5.1).
Why do these findings matter?
Routine screening for distress can help identify cancer patients’ psychological, social, spiritual, practical or physical concerns. The Edmonton Symptom Assessment System (ESAS) is the most frequently used self-report screening instrument in Canada. It measures nine commonly reported symptoms (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, lack of well-being and shortness of breath).6 Another tool in common use to screen for problems or concerns of cancer patients is the Canadian Problem Checklist.6
Routine screening alone, however, is not sufficient for addressing the needs of cancer patients. To have a positive impact on patient well-being, screening must be accompanied by adequate follow-up and intervention as required (e.g., further assessment, change in care plans, physical and psychosocial intervention, referral to another practitioner and ongoing monitoring of symptoms).1,7It is also important to evaluate the effectiveness of these programs within specific clinical settings, as well as their impact on identifying patient needs. Future measurement efforts will focus on the percent of patients using the tools, the results of the assessments and the extent to which patient-reported symptoms are reduced as a result of management efforts by providers.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Distress Management Version 3.2015. 2015.
- Jacobsen PB. Screening for psychological distress in cancer patients: challenges and opportunities. J Clin Oncol. 2007;25(29):4526.
- Skarstein J, Aass N, Fosså SD, Skovlund E, Dahl AA. Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res. 2000;49(1):27-34.
- Kennard BD, Stewart SM, Olvera R, Bawdon RE, Hailin AO, Lewis CP, et al. Nonadherence in adolescent oncology patients: preliminary data on psychological risk factors and relationships to outcome. J Clin Psychol Med Settings. 2004;11(1):31-9.
- Von Essen L, Larsson G, Oberg K, Sjödén P. ‘Satisfaction with care': associations with health-related quality of life and psychosocial function among Swedish patients with endocrine gastrointestinal tumours. Eur J Cancer Care. 2002;11(2):91-9.
- 86. Linden W, Yi D, Barroetavena MC, MacKenzie R, Doll R. Development and validation of a psychosocial screening instrument for cancer. Health Qual Life Outcomes. 2005;3:54.
- Canadian Partnership Against Cancer CJAG. Guide to Implementing Screening for Distress, the 6th Vital Sign: Moving Towards Person-Centred Care. Part A: Background, Recommendations and Implementation. Toronto (ON): 2009 May 21.