Oral Papers: Palliative Care & Oncology I
Background: Distress and depression are prevalent among cancer patients and are associated with adverse psychological and medical outcomes. While distress and depression screening with referral to appropriate psychosocial treatment services is now a requirement for designated cancer centers, it is unknown what effect a standard outpatient consultation-liaison (CL)-based psycho-oncology intervention has on remediating these factors. This study describes the effect of two one-hour psycho-oncology visits on distress and depression among a representative cohort of cancer patients.
Methods: This is a single site, prospective observational study of adult patients with a primary diagnosis of cancer who were referred for psycho-oncology services. Patients were seen for 1-2 visits, with each visit consisting of a one-hour intervention (pharmacotherapy and/or psychotherapy). Patients completed the Distress Thermometer and Problem Checklist (DT+PL) and Patient Health Questionnaire (PHQ-9) at the beginning of their first (PRE1) and second visit (PRE2). The DT was administered again at the end of these visits (POST1, POST2). A Wilcoxon signed rank test was used to test for significance of distress and depression score reduction.
Results: The current analysis included 174 patients seen once and 69 patients seen twice, with an average duration between visits of 20 days. Average distress score was 5.56 [SD=2.64] at PRE1, 3.85 [SD=2.43] at POST1, 4.92 [SD=2.91] at PRE2, and 3.43 [SD=2.79] at POST2. There was a significant distress reduction immediately post-intervention at visits 1 and 2, with significantly lower distress at POST1 (p< 0.001) and POST2 (p< 0.001) than PRE1 and PRE2, respectively. There was also a significant distress reduction from PRE1 to POST2 (p< 0.001). PHQ-9 scores were significantly reduced from PRE1 to PRE2 (scores 8.79 [SD=7.18] and 7.57 [SD=6.96], respectively, p=0.0020).
Discussion: Psycho-oncology interventions significantly reduce distress and depression. Distress scores were significantly lower immediately post-intervention. After two psycho-oncology interventions, there was a significant overall reduction in distress when compared to baseline (PRE1) scores. PHQ-9 scores also showed a significant reduction at visit 2, suggesting that the anti-depressant benefit of a psycho-oncology intervention was sustained across visits. Importantly, reductions in distress and depression were clinically meaningful, with scores post-intervention no longer meeting criteria for clinically significant distress (DT scores ≥ 4) and depression (PHQ-9 scores ≥ 8) as at pre-intervention. These findings support the use of CL psycho-oncology interventions for distress and depression in cancer patients and add to the limited evidence in the literature regarding the efficacy of these interventions.
Conclusion: This study demonstrates that brief psycho-oncology interventions are effective at significantly reducing distress and depression from clinically significant to non-clinically significant levels. Further research is needed to explore the sustained benefit of these interventions as well as potential determinants moderating their efficacy.