Aim
To identify the number, type, and predictors of problems reported by patients completing screening for anxiety and depression in NSW cancer services.
Methods
Screening using the Distress Thermometer(DT) and Problem List was completed in clinic or via email by patients within a cluster randomised trial of the ADAPT clinical pathway, in five cancer services at agreed intervals (usually 3 monthly) over 12-months. The Problem List comprises 39 items in 5 themes: practical, family, emotional, spiritual and physical.
Results:
512 patients (61% female) participated. 256 patients (28%) completed screening once, 140 (15%) twice, 85 (9%) three times and 31 (3%) four times (915 screening events). Patients reported a total of 6,314 problems; the average number of problems declined over screens (15 at first screening, 6 at second, 2 at third and fourth screening). Physical issues were most commonly reported (63%), followed by emotional problems (26%).The most common problems (3950 problems) at first screens were fatigue (9%), worry (7%), and sleep (6%). At second screening (1571 problems): fatigue (9%), worry (7%), sleep, pain, and dry/itchy skin (6%). At third screen (588 problems): fatigue (9%), worry (7%), tingling hands/feet, pain, memory/concentration (6%). At fourth screening (205 problems): sleep and worry (7%), fatigue, skin dry/itch and dry/congested nose (6%). Patients reporting elevated distress on the DT (score ≥ 4), indicated more emotional problems (33%) than those with lower distress (≤3) (20%). Those scoring ≤3 on DT reported more physical problems (71% vs. 58%).
Conclusion
Fatigue, worry and sleep are persistent problems for patients with cancer. Emotional problems appear to cause higher distress. Mean number of problems declined over time, inferring that problems resolved, through intervention or symptom changes. Screening provides opportunities to identify and respond to individual issues and identify potential gaps to identify potential gaps to guide information and support provision.