ASCO GU 2018: Distress Prevalence and Associated Risk Factors within the Urothelial Cancer Population
For this study, the authors performed a retrospective review of distress screening outcomes in bladder cancer patients seen in an oncology outpatient clinic at the Cleveland Clinic between January 1, 2016-October 1, 2017. Established oncology patients were screened for distress every 30 days using the Patient Health Questionnaire-9 (PHQ-9) and/or the NCCN Distress Thermometer. Questionnaires were completed on an electronic tablet at the time of check-in and linked to the Epic electronic medical record in real time. A data capture program was used to query screening outcomes and identify those who met critical threshold scores (PHQ-9 > 8, NCCN Distress Thermometer > 4).
There were 153 patients with a primary diagnosis of bladder and 81 (53%) completed the PHQ-9 (n = 67) or NCCN Distress Thermometer (n = 16). The overall incidence of distress was 13.6% with an average score of 12.3 on PHQ-9 (n = 10) and 9 on NCCN Distress Thermometer (n = 1). Of the patients with elevated distress, there were seven males and four females with a mean age of 64 and 77, respectively. All were either married or widowed and metastasis was documented in 45%. Five were on an antidepressant and only one had mood disorder previously documented in the history. A social work referral occurred for 73% of the patients. One patient had elevated distress in the 6 months subsequent to diagnosis. Of the seven now deceased patients, all had elevated distress within 6 months of death.
The authors concluded that the prevalence of distress was 13.6% among patients with urothelial cancer and less than that in general oncology. Metastatic disease and female gender were risk factors while documentation of a psychiatric condition was not. Furthermore, all now deceased patients had endorsed elevated distress within 6 months of death. Given the small sample size of this study, these results require further validation in larger cohorts.
Presented by: Laurel Ralston, DO Cleveland Clinic Foundation, Cleveland, OH
Co-Author: Petros Grivas
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
References:
1. Apolo AB, Infante JR, Balmanoukian A, et al. Avelumab, an anti-programmed death-ligand 1 antibody, in patients with refractory metastatic urothelial carcinoma: Results from a multicenter, phase Ib study. J Clin Oncol 2017;35(19):2117-2124.