Increasing Psychological Referrals for Lung Cancer Patients with Depression and Anxiety: Experience with ASCO Screening and Treatment Guidelines
Loading...
Date
2024-05
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
The Ohio State University
Abstract
Lung cancer patients report some of the highest levels of depression and anxiety of all cancer types. To provide patients with an avenue for psychological treatment, hospitals and clinics may refer patients to psychological services. In 2023 the American Society of Clinical Oncology released guidelines for screening adult cancer patients with depression and anxiety. For the present study, ASCO guideline-recommended screening measures (Generalized Anxiety Disorder-7 [GAD-7], Patients Health Questionnaire-9 [PHQ-9]) were administered to an observational cohort of individuals with stage IV lung cancer (N = 287; NCT03199651). 60 (21%) of patients exceeded cutoffs (PHQ ≥ 8 and/or GAD ≥ 10) and 227 (79%) did not. If a patient screened “positive” the respective oncologist received a letter notifying him/her of the symptom elevations and recommending a psychological evaluation follow-up. In 2/2023, a medical record search for all patients determined instances of referrals to psychological services. For patients with a positive screen (n = 60), 23 (38%) were referred to a psychological service but the majority 37 (62%) were not. For added clarity, post hoc analyses contrasted characteristics of the positive, referred patients versus the positive, not referred patients. Referred patients did not differ significantly from those not referred on any measure or sociodemographic, except being somewhat younger (57 versus 64). As this example suggests, lung cancer patients have high rates of depression and anxiety, making screening a critical, necessary step. However, patients’ actual care paths thereafter are little examined, and the majority of positively screened patients studied here did not have a referral for further psychological evaluation and/or treatment. Achieving a second step of referral is complex. Data suggest notification to a patient’s physician may be insufficient to eventuate in patients’ mental health care, with the need to examine the processes following screening to ensure guideline-recommended mental health care.
Description
Keywords
Oncology, Referral, Psychosocial, Psychological, Screening, Mental Health