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February 1, 2005 • Volume 2 / Number 5 E-Mail This Document  |  Download PDF  |  Bulletin Archive/Search  |  Subscribe

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Community UpdateCommunity Update

Distress Treatment Guidelines Address Void in Cancer Care

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Cancer patients usually experience varying levels of distress about their disease, treatment, and prognosis. These negative but understandable feelings of anxiety and depression can frequently be severe enough to impair patients' daily lives and abilities to comply with treatment regimens. However, only about 5 percent of cancer patients receive any psychological help for these very real problems related to their primary disease condition.

To address this void in cancer care, the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) announced the release of Distress Treatment Guidelines for Patients. The 32-page booklet was developed by an NCCN panel of 23 cancer experts to enhance patients' lives, support patient-doctor communications, and increase the success of cancer therapies by increasing patient compliance with treatment plans.

The NCCN guidelines were initially developed to help clinicians respond to their patients' distress symptoms. However, "given the busy oncology offices today, there is often not enough time for doctors to ask about distress," noted Dr. Jimmie Holland, a psychiatrist at Memorial Sloan-Kettering Cancer Center, who chaired the NCCN panel. She has found that "most cancer patients are reluctant to bother the doctor and feel it would be a sign of weakness to mention their distress. These guidelines make it easy for patients to assess their level of distress and take positive steps to reduce it."

At the heart of the guidelines is a "Distress Thermometer," an easy-to-use screening tool to assess the level of patient distress (on a 0-10 scale). Patients are provided with a problem list to help pinpoint their reason(s) for distress. The list covers common problem areas such as: practical (housing or child care), family (dealing with children or partner), emotional (worry and sadness), spiritual or religious concerns (loss of faith), and physical (pain, diarrhea, or appetite).

The guidelines recommend that patients who score 5 or higher on the Distress Thermometer ask for referrals to mental health, social work, or pastoral services. The NCCN booklet also provides in-depth descriptions of psychosocial and practical problems that can occur during cancer treatment and resources that are available to help patients cope.

"We are very pleased to once again be collaborating with NCCN, this time on the Distress Treatment Guidelines for Patients," said Dr. Stephen Sener, president of ACS and vice chairman of the Department of Surgery at Evanston Northwestern Healthcare in Chicago. "By making these NCCN guidelines accessible, we are ensuring that patients and their caregivers will be on the same page when it comes to discussing the level of distress associated with cancer diagnosis and treatment."

These guidelines were developed in response to, and to attempt to help NCI meet, the recommendations in the Institute of Medicine's report on improving quality care in cancer and in the President's Cancer Panel report on cancer survivorship for improved access to psychological support for cancer patients/survivors and their families across the course of care. NCI continues to play a key role in the direction and support of research to establish the evidence base for interventions with potential to improve the emotional and social well-being of those diagnosed with and treated for cancer.