Do cancer survivors experience disparities in receiving distress screening?

Challenge

Approximately 1 in 3 cancer survivors experience psychosocial distress. While positive social support and good mental health is associated with longer survival and better health outcomes, lung and ovarian cancer survivors experience high levels of distress and relatively low 5-year survival rates. Since 2015, the American College of Surgeons’ Commission on Cancer (CoC) has required routine distress screening for cancer program accreditation.

The objective of this study for the Centers for Disease Control and Prevention (CDC) was to

• Examine the extent to which ovarian and lung cancer survivors receive distress screening
• Understand the processes of screening and follow-up care, including referrals for psychosocial assessments and interventions

Solution

Using a multilevel mixed-methods approach, Westat reviewed 2,250+ patient records and conducted key informant interviews and focus groups with health care administrators and practitioners.

We worked with the CDC and collaborated with the CoC to enroll 21 cancer facilities, ranging in size, urbanicity, and demographic characteristics, using a highly adaptive onboarding protocol.

Westat established formal agreements with facilities to remotely access patient electronic health records (EHRs) for data abstraction. For each distress screening instance, study staff documented information, such as location and type of visit, as well as types of follow-up assessments and referrals to intervention services.

Results

Distress screening was offered to just over half (55%) of lung and ovarian cancer survivors. Of survivors who received an assessment, only 39% with identified needs were referred for further services.

Disparities existed across race/ethnicity, cancer type, cancer stage, and rurality of cancer facility. Specifically, those more likely to be screened for distress were White and African American patients, lung cancer patients, those diagnosed at later stages, and patients in rural facilities. Health care practitioners suggested that screening across several points in time, using patient-administrated methods, and enhancing EHR infrastructure may improve the distress screening process.

Study results may be used to enhance the quality of cancer care delivery to ensure that cancer survivors receive appropriate psychosocial care.