When severe and left untreated, distress can have a significant impact on health outcomes, lead to greater mortality and morbidity, affect immune function, and result in higher health care expenditures through more frequent use of medical services, such as emergency department (ED) visits. To combat these issues, the Commission on Cancer (CoC) put into place mandates for routine distress screening at cancer centers.

Researchers at the University of Michigan Comprehensive Cancer Center, led by Brad Zebrack, PhD, MSW, MPH, reviewed electronic health record (EHR) data from 55 cancer centers in the United States and Canada. The results showed that adherence to screening protocols led to 18% fewer ED visits and 19% fewer hospitalizations in the two–month period following the screening.

The study, “A Practice–Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization,” was published in the July 2017 issue of the Journal of the National Comprehensive Cancer Network.

According to Dr. Zebrack, utilization of distress screening protocols, such as the National Comprehensive Cancer Network® (NCCN®) Distress Thermometer, have the ability uncover incapacitating conditions that, left untreated, could have an incredibly negative impact on patient outcomes.

In many cases, coexisting psychosocial conditions inhibit adherence to therapy, and helping ensure that patients have access to appropriate support breaks down barriers to necessary clinical care and, essentially, better outcomes.

In 2015, the CoC established accreditation standards for patient–centered care that included a requirement for distress screening for all patients with cancer, as well as appropriate clinical response when warranted.

The University of Michigan study is the first to examine adherence among nonexperimental distress screening protocols. Of the 55 centers studied – 53 in the United States and two in Canada – EHRs for more than 8,400 patients were examined. Among those reports, 62% of patients received the mandated distress screening and follow up – the highest rates of which were reported by community cancer programs. Among National Cancer Institute (NCI)–designated cancer centers, less than half adhered to the protocol.

Moreover, regardless of care setting, adherence rates for adolescent and young adult patients (aged 15–39 years) were significantly lower (58%) when compared with other age populations. Researchers identified that the highest adherence rates (70%) were among black/African American patients, while the lowest adherence rates (45%) were found in patients of American Indian/Alaska Native/Native Hawaiian/Pacific Island descent.

The efficient use of scarce medical resources and the delivery of cost–effective care depends upon getting the right treatments to the right patients at the right times. Distress management protocols are critical for identifying and responding to the needs of patients. When left unchecked, unmet patient needs for psychosocial support contribute to poor patient outcomes and unnecessary use of costly medical services.

Among the cancer centers studied, 84% utilized the NCCN Distress Thermometer and Symptom Checklist – or a modified version thereof. This checklist, derived from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Distress Management, is similar to the pain scale used in various areas of medicine. The distress thermometer allows patients to self–identify their stress level from zero to 10, with 10 being an extreme level of distress. Under the guidelines, patients reporting above a "4" should be referred to supportive care that will best serve their needs.