M. McLeod1, C. Veenstra1, S. K. Hendren1, P. H. Abrahamse1, D. Jomaa1, A. M. Morris1 1University Of Michigan,Ann Arbor, MI, USA
Introduction: Baseline psychosocial distress among cancer patients is associated with poor patient-provider communication, reduced treatment adherence, longer inpatient stays, and poorer clinical outcomes. We hypothesized that several factors would be independently associated with baseline patient-reported distress, which in turn would be associated with poorer clinical outcomes in the setting of colorectal cancer.
Methods: Over one year, new colorectal cancer patients at the University of Michigan Comprehensive Cancer center were invited to complete the NCCN Distress Thermometer, Impact Thermometer and Problem List before their first visit. Additional clinical data were abstracted from the electronic medical record: age, sex, race, marital status, comorbidities, cancer stage and type, and clinical outcomes. We performed multivariable analysis to assess factors associated with patient-reported distress, and the association between distress and 30-day complications of surgery. We then conducted semi-structured interviews with patients selected based on quantitative analyses. We queried means of coping with the patient-reported physical, financial, practical, emotional and spiritual challenges posed by their cancer treatment. Interviews were recorded, transcribed, coded and discussed using rapid content analysis.
Results: Among 292 eligible patients with colorectal cancer who consented to participate, initial data abstraction was completed for 225. The average patient age was 61 years (range 27-91), and 58% were male. The mean Distress Thermometer score was 4.15 (range 0 – 10). Female sex (p<0.001), lack of a domestic partner (p<0.05), rectal cancer (p<0.01), and mental health comorbidities (p<0.001) were associated with greater distress in the multivariable analysis. 54% of patients had complications of surgery. Neither multivariable nor bivariate analyses demonstrated a correlation between distress and 30-day complications. In follow-up qualitative interviews, patients indicated that (1) a sense of their surgeon’s commitment to their physical and emotional well-being and (2) the presence of a trusted personal advocate enabled physical and emotional coping. Improved coping resulted in reduced psychosocial distress, and increased engagement in treatment.
Conclusions: These findings indicate the importance of the patient-surgeon relationship and the psychosocial benefit of a trusted personal advocate, usually a spouse, during cancer care. Although there was not a direct correlation between distress and surgical complications, these data support engaging the spouse or important others at the onset of multidisciplinary cancer care during the patient-surgeon interaction. Understanding the role that modifiable factors play in the progression of psychosocial distress provides a platform to facilitate patient coping, engagement, and satisfaction with care.