Social worker–driven distress screening among gynecologic oncology patients.

Abstract

e23153 Background: While all cancer centers are required to screen for distress, there is a lack of standardization regarding the screening process. Methods: We conducted a single-institution prospective intervention of standardized distress screening by an oncology social work (OSW) team from 8/2022 to 8/2023 and compared outcomes to a historical control group of patients who underwent non-standardized screening by office staff or nurses from the year prior. Patients 18 years and older with newly diagnosed gynecologic cancer were included. The National Comprehensive Cancer Network validated distress thermometer (DT) was used for screening. Comparative statistics were used to analyze differences in rates of DT screening, scores, and healthcare utilization between groups. Logistic regression analyses assessed for variables associated with improved screening within 1 year of diagnosis. Results: 169 underwent non-standardized screening while 141 patients met criteria for screening by OSW. Patients were on average 65 years old, predominantly White/Caucasian (88.4%), English speaking (92.3%), had uterine cancer (60.9%), early stage (I-II) disease (68.3%), and received surgery as initial treatment (75.8%), with significant differences in initial and all treatments received within 1 year of diagnosis (p = 0.01, p = 0.001) between the two screening groups. Rate of DT completion was 48.2% by non-standard screening compared to 53.9% by OSW (p = 0.35 ). The rate of moderate-to-severe distress was not different (39.7% vs 52%, p = 0.13). Significantly more referrals to support services were provided within the OSW group (42.7% vs 68%, p < 0.001). Multivariable logistic regression found that patients who were screened by OSW were 34% more likely to have completed screening within the first year of diagnosis, although this was not significant (aHR 1.34, 95% CI 0.97-1.86, p = 0.08). Patients with stage III and IV disease were more likely to complete DT regardless of screening group (p = 0.01, p < 0.001). Time to initial treatment, number of emergency department and hospital encounters were not different between the two groups. Conclusions: The standardized OSW distress screening process was 34% more likely to have completed screening, although this was not statistically significant. A resource-intensive screening process with OSW may clinically improve screening rates, however further research is needed to determine effects on clinical outcomes such as healthcare and resource utilization. Distress screening within 1 year of diagnosis. Protocol Overall Nonstandard OSW P value Screening completed 158 (50.9%) 82 (48.2%) 76 (53.9%) 0.35 Distress score, mean (SD) 3.48 ± 2.90 3.24 ± 2.99 3.73 ± 2.80 0.81 Any referral after screening 86 (54.8%) 35 (42.7%) 51 (68.0%) < 0.001 Time from consult to initial treatment, median 26 [15-43] 28 [15-43] 24 [15-37] 0.39 Moderate-to-severe distress (DT score ≥ 4) 70 (45.8%) 31 (39.7%) 75 (52.0%) 0.13