Matthew Loscalzo

Meta-analysis of screening and case finding tools for depression in cancer: Evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group

BACKGROUND To examine the validity of screening and case-finding tools used in the identification of depression as defined by an ICD10/DSM-IV criterion standard. METHODS We identified 63 studies involving 19 tools (in 33 publications) designed to help clinicians identify depression in cancer settings. We used a standardized rating system. We excluded 11 tools without at least two independent studies, leaving 8 tools for comparison. RESULTS Across all cancer stages there were 56 diagnostic validity studies (n=10,009). For case-finding, one stem question, two stem questions and the BDI-II all had level 2 evidence (2a, 2b and 2c respectively) and given their better acceptability we gave the stem questions a grade B recommendation. For screening, two stem questions had level 1b evidence (with high acceptability) and the BDI-II had level 2c evidence. For every 100 people screened in advanced cancer, the two questions would accurately detect 18 cases, while missing only 1 and correctly reassure 74 with 7 falsely identified. For every 100 people screened in non-palliative settings the BDI-II would accurately detect 17 cases, missing 2 and correctly re-assure 70, with 11 falsely identified as cases. The main cautions are the reliance on DSM-IV definitions of major depression, the large number of small studies and the paucity of data for many tools in specific settings. CONCLUSIONS Although no single tool could be offered unqualified support, several tools are likely to improve upon unassisted clinical recognition. In clinical practice, all tools should form part of an integrated approach involving further follow-up, clinical assessment and evidence based therapy.

Implementing touch-screen technology to enhance recognition of distress

Objective: The University of California, San Diego, Moores Cancer Center implemented a systematic approach for patients to communicate with their health‐care team in real‐time regarding psychosocial problem‐related distress using touch‐screen technology. The purpose of this report is to describe our experience in implementing touch‐screen problem‐related distress screening as the standard of care for all outpatients in a health‐care setting. Although early identification of distress has recently gained wide attention, the practical issues of implementing psychosocial screening with and without the use of technology have not been fully addressed or investigated.

Psychological distress in patients with pancreatic cancer—an understudied group

Background: Pancreatic cancer is the fourth leading cause of cancer‐related death in the United States, unsuccessful in significantly improving 5‐year survival. A diagnosis of pancreatic cancer may be associated with increased psychological distress, yet remarkably little is known about the degree of psychological distress experienced by these patients at the time of diagnosis and treatment.

Successful strategies for implementing biopsychosocial screening

Objective: This commentary integrates successful screening implementation strategies applied in four institutions in the United States and the accumulated knowledge from international leaders about how to engage key professionals and administration in partnering to create a culture of screening.

Factors associated with high burden in caregivers of older adults with cancer.

Older adults with cancer are vulnerable to functional decline, which places greater onus on caregivers. Few studies have prospectively examined burden in caregivers of older cancer patients. The objective of this study was to determine the factors associated with high caregiver burden.

Validation of a needs‐based biopsychosocial distress instrument for cancer patients

People with cancer may experience distress related to diagnoses, disease‐related symptoms, and treatment side effects. Assessment of cancer‐related needs can facilitate timely triage and intervention and contribute to individualized comprehensive cancer care. This study assessed the internal consistency, test–retest reliability and construct validity of the Cancer Needs Distress Inventory (CaNDI), a self‐report, needs‐based measure of cancer‐related distress.

From Distress Guidelines to Developing Models of Psychosocial Care: Current Best Practices

Psychological distress has been recognized as having a significant effect upon cognitive and emotional functioning, quality of life, and in some populations increased costs of care. Screening for distress and provision of psychosocial care in oncology treatment settings has been identified as a future accreditation standard by the American College of Surgeons Commission on Cancer (CoC). Because there are few available models of programs of distress screening and referral to inform oncology social workers and other members of the psychosocial support team with planning their own programs, this article seeks to provide exemplars of best practices that are currently in place in four different settings where psychosocial support is provided to people living with cancer and their families. Each program will provide an overview of how it was successfully established and its contribution toward evolving evidence-informed best practices.

Biopsychosocial problem-related distress in cancer: examining the role of sex and age.

The current study explores how sex and age relate to biopsychosocial distress by applying a large‐scale analysis among individuals diagnosed with a variety of cancers.

Partners' clinic: an innovative gender strengths‐based intervention for breast cancer patients and their partners immediately prior to initiating care with their treating physician

It is well documented that women with breast cancer report high levels of distress [1]. However, partners of breast cancer patients are often as distressed as patients themselves [2]. A partner is an important component of the patient’s support system during a breast cancer diagnosis and throughout treatment [1]. Women have better psychological adjustment to their illness if their partners are emotionally supportive, but this is often where partners struggle the most [3,4]. Furthermore, positive relationships with many supportive friends do not compensate for a problematic partner relationship [3,5]. Despite this knowledge, there are few successful therapeutic models that foster an environment where women and their partners can identify their unique contributions to coping and make positive emotional connections during times of acute stress. The purpose of this correspondence is to describe a unique gender strengths-based intervention (Partners’ Clinic), report distress screening and satisfaction data for both the patient and their partners, and demonstrate the feasibility of providing a couples intervention early in the treatment continuum. Partners’ Clinic engages women and their partners in a psychoeducational consultation with clinician-educators immediately prior to their initial surgical consultation. Partners’ Clinic was developed using a psychoeducational and gender strengths-based theoretical framework. Educating pairs about their illness, treatment, and coping skills while integrating cognitive-behavioral and supportive therapeutic components can lead to reduced illness related distress [4,6]. The foundation of a gender strength-based approach is based on the belief that positive change occurs in the context of authentic relationships, every person has unique strengths, the importance of valuing differences, and the need to collaborate [6,7]. The goal is to maximize the ability of women and men to increase their emotional connection and problem solving skills despite the challenges of cancer. (See examples in Intervention)

A Unique Interactive Cognitive Behavioral Training Program for Front-Line Cancer Care Professionals

For between one third and one half of all cancer survivors, disturbances in mood and cognition do not end with the conclusion of treatment. Recognizing this problem, the Institute of Medicine emphasized in its 2008 report, the importance of addressing psychosocial issues, such as distress, to providing quality cancer care. The National Cancer Institute (NCI) has recognized that there is a severe lack of trained professionals who can address these needs. In response to this need, an interactive training program was developed and implemented to teach frontline cancer care professionals Cognitive Behavioral Therapy (CBT) skills. This training includes a structured curriculum, centered around a 3-day training workshop that includes didactic discussion, small group interactive sessions, role playing, post course support, and follow-up evaluation. Four of the planned eight workshops have been conducted thus far and indicate successful recruitment and implementation of a unique training model related to the CBT skills learned.