Psychosocial distress is not uncommon among patients with cancer. As a result, the American College of Surgeons Commission on Cancer has mandated psychosocial distress screening of patients at accredited cancer programs.

However, few studies have been conducted on patients at safety net hospitals who may be experiencing additional distress due to unique challenges such as language and cultural barriers as well as difficulty accessing supportive services. So, a team of researchers set out to evaluate psychosocial distress in breast cancer patients at a safety net hospital so they could characterize risk factors for high distress scores. Their findings were published in Clinical Breast Cancer.

The researchers analyzed a series of psychological distress screening forms completed by 171 patients with breast cancer, as well as the patients’ demographics and clinical data. All of the patients were female, 63% were Hispanic, and 12% were African American. Spanish was the primary language for 56% of the patients, followed by English (38%). All of the patients had stage I, II, or III disease.

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Psychological distress scores were reported in 21.3% of the 755 forms, which represented 79 unique patients. However, 808 screenings from 152 unique patients (79%) indicated low distress.

“Patients with a new diagnosis of cancer, or who were in active treatment, represented a higher proportion of patients who reported a high distress score, while patients who were in active surveillance and without evidence of disease represented a higher proportion of patients with a low distress than those with a high distress score,” explained the researchers.

These findings correspond to previous studies that showed psychological morbidity was more prevalent immediately after cancer diagnoses. Patients with a diagnosis of invasive breast cancer were more likely to have a higher distress score than those with a diagnosis of DCIS.

However, age, race/ethnicity, or primary language spoken were not associated with greater distress.

The researchers suggested that ongoing surveillance for distress was useful. Further research into the referral system and resources that would have the greatest impact on reducing distress may help these patients as well.

“More patients report emotional problems over practical concerns, and referrals to support groups or psychological counseling should be considered in these patients, and not dismissed,” the researchers reported, adding that distress can occur at any point, which illustrates the benefit of ongoing surveillance.

The study was limited by a sample size of just 171 women, none of whom had metastatic disease. Safety net hospitals such as the one in this study may also be challenged by lack of routine and systematic screenings.


Liu JK, Kaji AH, Roth KG, et al. Determinants of psychosocial distress in breast cancer patients at a safety net hospital. Clin Breast Cancer. 2021;22 (1):43-48. doi:10.1016/j.clbc.2021.06.011