Real-world patterns and outcomes of cancer-related distress assessed by the NCCN distress thermometer in community oncology practice in western India.

Abstract

e13578 Background: Cancer-related distress can adversely affect treatment adherence and quality of life, yet real-world evidence from Indian community oncology settings on this issue remains scarce. Methods: Adult Cancer patients were retrospectively assessed with NCCN Distress Thermometer between April 2025–December 2025. Distress was evaluated across physical, emotional, practical, social and spiritual domains at baseline and follow-up. Associations with age, disease stage and diagnosis were analyzed. Changes over time were assessed using Wilcoxon signed-rank test. Results: Among 2273 patients evaluated, the median age of the cohort was 58.3 years (SD 13.1) with M:F ratio of 1:1.4. Most patients had ECOG PS 0–1 (54.1%) and presented predominantly with stage IV disease (45.8%).The common cancers evaluated were breast (n = 570,25%), gastrointestinal (n = 360, 15.8%), gynaecologic (n = 297,13%) & head & neck cancers ( n = 224,9.8%). Mean distress score significantly reduced from 5.2 at baseline to 3.5 at follow-up (p < 0.001) with median scores improving from 5 to 3. A total of 57.4% had baseline distress scores ≥5 and it was associated with stage IV disease (p = 0.040); baseline distress was higher in patients < 60 years (p < 0.001). Overall 50.7% improved, 42.8% remained stable & 6.5% worsened. Improvement rates were consistently high across cancer types (≈67–79%), most common in Breast (79.3%), lymphoma (76%) and Head & Neck (75.5%). Improvement was significantly higher in younger patients 75% vs 64% in elders (p = 0.014) & in those with early-stage disease (stage I–II) 78% vs stage III–IV 66% (p = 0.016). Most commonly reported concerns were : in the physical (n = 1925,84.6%; including pain 59.5%, fatigue 50.7% & changes in abilities 45.7%), emotional (n = 1804,79.4%; anxiety 69.2%, sadness 26.8%), and practical (n = 1780,78.3%; self-care 84.2%, finances 22.7%); while fewer reported were social (n = 625, 27.5%) or spiritual/religious (n = 365, 16.1%) concerns. Across breast, gastrointestinal, gynecologic, and head and neck cancers, physical (n = 1,258) and emotional (n = 1,199) concerns were the two most prevalent domains. Conclusions: Routine implementation of the NCCN Distress Thermometer in community oncology practice in Western India enabled systematic identification of multidimensional distress and was associated with significant, tumor-agnostic improvement in patient-reported distress, highlighting its clinical utility as a pragmatic supportive care screening tool in real-world Indian settings.