ó When the staff at Abington Memorial Hospital handed the
breast cancer patient its new "Distress Thermometer"
questionnaire, she instantly felt conflicted.
could she, an early-stage patient with a good prognosis, say
how she was really feeling when she saw how much worse off
others in the radiation-treatment waiting room were? She left
later the staff asked again. Come January, cancer programs
that want accreditation from the American College of Surgeonsí
Commission on Cancer will be required to formally ask all
cancer patients about their psychosocial needs. Breast cancer
patients were among the first to test the new program at
time the woman decided to tell the truth. She was doing OK
with the cancer itself, but was really upset about the way
some people she had counted on were handling it. She was on
the verge of tears all the time.
staff sent her to social worker Mary Oleksiak. They talked for
an hour and a half.
was really helpful for me," said the patient, who did not
want to use her name for fear it would make her troubling
relationships even worse. "Mary gave me a lot of things
to think about."
was enlightened as well. She had thought the hospital was
doing a good job of finding patients who needed help, but here
was one who would have flown under the radar without the
survey. How many more would be uncovered by the questions,
which the hospital began giving to all cancer patients
others who direct psychosocial services, she is bracing for
the possibility ó she still thinks itís remote ó that
demand for help will jump when patients have more
opportunities to say whatís bothering them.
anxious moments, Oleksiak thinks, "Iím only one person
and my phone is going to be constantly ringing off the
Miller, a nurse who is administrative director of the Womenís
Cancer Center at Fox Chase Cancer Center, also wonders.
"This next year is going to be extremely telling,"
should surprise no one that a cancer diagnosis starts a
patient on an arduous emotional journey as well as a medical
might be more of a surprise that only now are hospitals being
required to ask their patients about their
"distress," a pallid word for the massive jolt to
the psyche ó and sometimes the pocketbook ó that an
encounter with a potentially deadly disease delivers.
Accredited hospitals also must help patients find the services
they need, either in their own health system or elsewhere in
Commission on Cancer accredits 1,500 cancer programs that care
for about 70 percent of the nationís cancer patients. Daniel
McKellar, chair of the organization, said its new approach
stemmed from a 2007 report from the Institute of Medicine
called Cancer Care for the Whole Patient: Meeting Psychosocial
Health Needs. It concluded that problems with emotions or more
practical matters like transportation add to suffering and can
make it harder for patients to follow doctorsí orders and
get better. Experts believe distress management programs
improve quality of life and communication.
is an important part of modern cancer care," McKellar
than two months before the new distress rules go into effect,
many area cancer programs are still fine-tuning their
there is a mandate, there is a business opportunity, and
Polaris Health Directions, a Wayne, Pa., company with a long
history of measuring psychological problems, is pleased by
demand for its newly commercialized distress evaluation tool.
The company says it has sold the product, at an annual cost of
$25,000 to $50,000 a year, to 60 centers in the last 18
Web-based tool can integrate with electronic medical records
and generate treatment suggestions based on a patientís
insurance and address.
nonprofit Cancer Support Community has also developed a tool
it sells for a "nominal" fee, said Linda House, the
groupís executive vice president for external affairs.
products are competing with the Distress Thermometer, which
was created by the National Comprehensive Cancer Network and
is free, and with questions developed by individual hospitals.
many hospitals have been trying for years to assess whether
patients were having trouble, although McKellar pointed out
they might not have done much more than say, "Hi. How are
you?" They are unlikely to find out how patients are
really feeling unless they ask more probing questions, he
recent Cancer Support Community survey, 35 percent of patients
seen at comprehensive cancer centers and half of those at
smaller centers said they were not screened for distress.
large centers locally offer a host of free services for
patients who need counseling, help with nutrition, or stress
management. Social workers address financial and
transportation issues. Insurers do not pay for many of those
services. Smaller centers typically have less to offer.
are struggling with how to collect useful data while keeping
things easy for patients. Officials at Cooper University
Hospital, in Camden, N.J., love the way the Polaris tool can
collect and analyze data and generate referrals, but Fox Chase
switched to the Thermometer after patients in a pilot program
complained the Polaris survey took too long.
Medicine has taken a low-tech approach, asking patients since
August just four questions, on paper, about anxiety and
depression and following up, when needed, with face-to-face
talks with social workers.
Sidney Kimmel Cancer Center at Thomas Jefferson University is
testing several surveys, including one it developed itself.
That one includes a question on concerns about sexuality that
many patients have checked off. "Thatís been
eye-opening," said Greg Garber, supervising social
general, surveys flag 35 to 40 percent of patients as having
high levels of distress. So far, local hospitals say the
number of patients who actually want or need services has been
said all that many patients need is information, assurance
that their feelings are normal, and time to adjust to
disturbing news and decisions. "Information is a very
powerful distress reducer," he said. Many patients also
feel better when they have a treatment plan or see what
chemotherapy is really like.
15 or 20 percent may have a "frank psychiatric
disorder," he said. Many of those patients were having
emotional problems before cancer added money woes, job
problems, and family upheaval. It can be hard to find
psychiatrists comfortable working with patients with severe
medical problems, he said.
Sheaffer, director of patient and family services at Pennís
Abramson Cancer Center, said patients had responded well to
questions about their mental health and information about the
help Penn can offer them.
she said, "are really, really thankful."