A relatively brief screening test can give caregivers a good indication of which cancer survivors are emotionally distressed and may benefit from further psychological evaluation, according to new research by a team of Dana-Farber Cancer Institute investigators.

In a study published in the Journal of Clinical Oncology, the researchers found that childhood cancer survivors whose screening scores indicated they were dissatisfied with their physical appearance, were in poor physical health, or had been treated with head radiation had an increased risk of experiencing psychological distress.

The findings have prompted researchers to begin developing a computerized survey that clinics across the country can use to identify cancer survivors who are in the greatest need of psychological counseling.

"When people who have been treated for cancer visit their doctor or a survivor clinic, there's a vast amount of material to cover: their physical health, emotional health, nutrition, the state of their relationships with their families, their work life," says the study's lead author, Christopher Recklitis, Ph.D., M.P.H., of Dana-Farber. "To make the best use of patients' and caregivers' time, we found it helpful to have an advance idea of which patients are having emotional difficulties, so their needs can be addressed promptly.

In this study, the researchers wanted to find whether it is practical to administer a psychological screening questionnaire to survivors in a clinical setting, and whether it could help identify those with significant psychological distress.

Investigators gave screening questionnaires to 101 adult survivors of childhood cancer who had appointments at the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber, which provides health and counseling services to survivors. The questionnaires were customized versions of standard psychological-screening tests. Survivors completed them while waiting for their appointments.

The vast majority of the respondents completed the screening in less than 30 minutes. Sixty-four percent indicated the survey would be "very" or "moderately" helpful in educating their clinicians about their emotional state.

About 30 percent had scores indicating they were in significant psychological distress, notes Recklitis, who counsels Perini Clinic patients. When he and his colleagues analyzed the results in detail, they found three risk factors that were associated with psychological distress: a dissatisfaction with physical appearance, poor physical health, and having been treated with cranial radiation as a patient.

"These results will help reach out to patients who are most likely to be distressed," says Recklitis. "Although this screening instrument was studied only in the setting of the Perini Clinic, we hope to develop it for use at other clinics as well."

SOURCES:
Journal of Clinical Oncology, March 1, 2003
Dana-Farber Cancer Institute (http://www.dfci.harvard.edu)