Outcomes associated with distress thermometer (DT) screening among patients with cancer: A retrospective, observational study in the US community oncology setting.

Abstract

e23295 Background: The DT is widely used to screen patients, especially those with cancer, for psychological distress and health-related social needs. DT-guided interventions can alleviate distress, which is associated with worsened health outcomes. Despite the relationship between distress, outcomes, and interventions, limited research has evaluated utilization of the DT following its implementation in electronic health record (EHR) systems of community oncology practices and associated impact on outcomes among patients with cancer. Methods: This retrospective, observational study included patients treated in US community oncology clinics after the DT was integrated into the iKnowMed EHR (in July 2023). Adult metastatic cancer patients with a clinic visit between 7/1/2023-11/30/24 were categorized based on whether they had DT screening after their metastatic diagnoses. DT utilization patterns were analyzed descriptively. Results: Among 46,657 eligible patients, 7,735 (17%) completed DT screening in the EHR and 38,922 (83%) did not, including 250 who declined. Demographic and clinical characteristics of patients with and without DT screening were similar, with breast cancer being the most common diagnosis (18%), followed by prostate (16%) and lung cancer (13%). The median (interquartile range [IQR]) follow-up durations were 13 (7, 16) and 12 (6, 16) months for patients with and without DT screening, respectively. The median (IQR) time from first visit after 7/1/2023 to DT screening was 9 weeks (0, 28) and 54% (n = 4,177) patients completed the DT screening on multiple visits. Clinically elevated initial distress (score≥4) was observed among 28% (n = 2,185). On the initial problem list, 52% (n = 4,054) reported physical, 36% (n = 2,790) emotional, and 29% (n = 2,250) practical concerns. Among patients with elevated distress and multiple DT overall scores during the observation period (n = 973), 70% (n = 667) of those with multiple screenings demonstrated improvement at follow-up. Conclusions: During this early EHR integration period, fewer than 20% of patients with metastatic cancer were screened in the EHR. Nonetheless, of those screened, one-quarter of patients initially reported experiencing moderate-to-severe distress. The majority of these patients with multiple DT screenings reported improved distress at follow-up. Further analyses are planned to evaluate DT screening patterns over time and factors that may influence receipt of the DT, as well as DT-associated outcomes adjusted for patient and disease characteristics.