Patients with cancer frequently experience significant distress that can be unrecognized by others. Untreated cancer-related distress has been shown to negatively affect adherence to cancer treatment, compliance with surveillance screenings, quality of life, and even survival rates.
Michelle Riba, MD, director of the PsychOncology Program at the University of Michigan Rogel Cancer Center, and Julianne Oktay, PhD, professor emeritus at the University of Maryland, offer tips for how clinicians can help their patients with cancer-related distress.
Know the different faces of cancer-related distress. Cancer-related distress is not limited to psychological problems, such as depression and anxiety. Patients can also experience distress regarding practical issues, family difficulties, spiritual and religious concerns, and physical problems.
“Patients could be worried about financial issues or transportation issues or their children,” Riba says. “People can also experience distress about physical symptoms related to cancer and cancer treatments.”
Screen for cancer-related distress. Patients are often appreciative of physicians who bring up the topic of distress, Oktay says. “[Many] physicians may not want to ask about distress because they think the patient will be upset or they don’t know what to do about it,” Oktay explains. Both Oktay and Riba suggest becoming familiar with the National Comprehensive Cancer Network’s Distress Thermometer, a visual analog tool similar to the pain scale. The tool also includes a problem list to identify specific issues. “This can be added to the patient’s pre-visit paperwork,” Oktay suggests.
Recognize the periods of increased vulnerability. “Distress is higher at certain times, such as around diagnosis or in the survivor period,” Oktay says. Other periods of high stress include admission to or discharge from the hospital, changes in treatments, recurrence or progression, and the transition to end-of-life care.
Offer help. When cancer-related distress is mild, “an empathic response, listening, or a gesture of concern can relieve distress,” Oktay suggests. In cases where more help is needed, clinicians can develop a list of resources for their patients that might include online groups (e.g., National Cancer Institute), survivorship programs, and support groups (e.g., Gilda’s Club).
For patients who require more advanced interventions, clinicians should consider referral to an oncology social worker. Riba recommends seeking out regional tertiary or cancer center networks that can provide clinician-to-clinician consultations or referrals.
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