Patients with pancreatic cancer frequently experience high levels of anxiety and distress, in part because the disease carries a poor prognosis, necessitating frequent clinic visits. To help identify and characterize patient distress, the University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, has utilized a distress thermometer (DT) screening tool at each clinic visit since 2005, according to a presentation at the Oncology Nursing Society 36th Annual Congress. The score is based on a patient’s rating of distress based on a visual analog scale from 0 to 10.
Using results from the DT, Janet Hampton, RN, BS, OCN® and colleagues analyzed 140 paired measurements that helped provide an understanding of issues that contribute to a patient’s distress and how best to alleviate that distress in those with a diagnosis of pancreatic cancer.
Specifically, they sought to understand if there was a change in distress level between initial consultation in a multidisciplinary pancreatic cancer clinic and development of a treatment plan and subsequent visits. Also determined was whether a correlation existed between DT scores and demographic variables of age, gender, ethnicity, performance status, stage of disease, treatment with curative (vs noncurative) intent, and weeks to death; and whether psychosocial concerns leading to increased distress in this population could be described.
At her institution, patients with pancreatic cancer undergo a multidisciplinary clinic evaluation to establish diagnosis, complete staging, and initiate a treatment plan. A DT score was collected at this initial visit and during follow-up visits on weeks 1 to 8. A DT score of 5 or higher prompted an evaluation by social workers to identify patients at high risk for psychosocial distress and also triggered increased interdisciplinary team participation in psychosocial care of these patients.
The average initial DT score was 5.29 (range, 0-10), which was not significantly associated with gender or treatment intention; however, young age was associated with a higher distress than those 65 years or older. Subsequent DT scores decreased in 60% of patients; remained the same in 18.6%; and increased in 21.41%. Correlation of the DT score with specific concerns noted by patients reported at the clinic visit was identified the top sources of distress as worry (58.6%), nervousness (52.9%), and disruptive sleep (41.4%). Other emotional concerns were fear, frustration, sadness, difficulty concentrating, depression, anger, and loss of interest. Spiritual and religious concerns focused on mortality; practical concerns included finances and insurance/benefits.
Using the DT screening tool has enhanced nursing, social work, and physician collaboration in addressing psychosocial concerns among patients with pancreatic cancer, lessening distress. Future goals include identifying factors that significantly increase distress levels so that interventions can be designed and incorporated into the care plan for these patients and their caregivers.