Abstract P4-19-04: Psychosocial distress monitoring in a multidisciplinary, inner city breast center
Authors: Castaldi M , Elrafei T , Soliman C 
Published: March 2017

Abstract
Objective: Beginning in 2015, all Commission on Cancer–accredited cancer programs must have developed and implemented a process to screen for psychosocial distress and provide appropriate psychosocial care. At our institution that serves uninsured and underrepresented minority populations, we integrated a distress tool on a continuum, rather than as a onetime event. We reviewed the initial screening tools from our breast center to determine how psychosocial distress differs throughout treatment in order to identify pivotal times during course of treatment and to prioritize intervention strategy.
Methods: NCCN distress thermometer was administered to each patient with review of stressors to complete at 4 different intervals after diagnosis with breast cancer. Newly diagnosed breast cancer patients were asked to complete distress screening at various phases of their cancer care: shortly after diagnosis at surgery office visit, after surgery at first chemotherapy cycle, third medical oncology office visit, and last chemotherapy cycle. The tools were administered by patient navigators and referred to social work with a distress score of 5/10 or higher. Tools were then scanned into the medical record and collected by the social worker. We reviewed the collected distress tools and compared the data based on the where the patient was in course of treatment. Identifying stressors were grouped into 4 categories: practical, family, emotional, and physical.
Results: in April 2015, the implementation and preparation of distress screening was begun. Between August 2015 and April 2016, 94 distress tools were completed by patients in our breast center. 42.5 % patients had a distress score of 5 or above at their initial screen at surgical consultation, 31.8 % at their first cycle of chemotherapy, 53.3% at third medical oncology office visit and 50 % at completion of chemotherapy, triggering a social work intervention. The most common stressors were emotional, worry and fear, (44%) at initial assessment and physical, fatigue and tingling in hands and feet, (100%) at last chemotherapy cycle, with family stressors 33.3 ?%, and practical matters 28%. The least common stressor was treatment decision or need for treatment change. Mean stress levels were 8/10 for surgical patients and 6/10 for patients seeing medical oncology. Although 4 screens were performed, the spectrum of stressors did not change significantly over continuum of care other than all patients reporting fatigue with a score of 5 or higher at completion of chemotherapy. All patients had psychosocial barriers to care that caused stress regardless of phase of cancer care.
Conclusion: Patients are at their peak stress levels at the time of diagnosis in consultation with the surgeon. As they move along their treatment plan, stress levels decrease, but the stressors seem to remain the same, except for physical stress being highest at end of chemotherapy. We recommend timing of the administration of the distress tools be based on capturing peak stress (at time of diagnosis) and then again at completion of chemotherapy to monitor for stress reduction. Addressing psychosocial barriers seems to be paramount in lowering distress scores in our underrepresented, minority breast cancer population.
Citation Format: Castaldi M, Elrafei T, Soliman C. Psychosocial distress monitoring in a multidisciplinary, inner city breast center [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-04.