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Benefits of Psychosocial Participation in a Head and Neck Cancer Tumor Board at the VA Palo Alto Health Care System: Two Case Examples
Background: Multidisciplinary tumor boards (MTBs) have been shown to positively impact the assessment and treatment of cancer patients (Pillay et al, 2016) and increase referrals to specialty services present at the meetings (eg genetic testing in breast cancer, Cohen et al, 2016). However, no research to date has explored the impact of involvement of psychosocial providers on MTBs. The following two cases are presented as examples of multidisciplinary cancer care that was facilitated by psychology/social work involvement in the Head and Neck Cancer MTB at VAPAHCS.
Case Report 1: Mr. T is an 86-year-old veteran who was referred to the Oncology and ENT services in May 2017 for a recurrent squamous cell carcinoma in the neck, presumably from prior lip primary. The patient evaluated by Oncology, KC, and ENT who recommended surgical resection. The veteran consented but later cancelled his surgery due to beliefs that God would cure him. The MTB reviewed his case, and the veteran agreed to return for a visit to the Oncology clinic. SD met with the veteran first, and then accompanied him to a meeting with the Oncologist who arranged a same day appointment with an ENT surgeon and an anesthesiologist. SD integrated the veteran’s belief systems (eg, that God would cure his cancer) to help facilitate his decisions. The veteran’s surgery was expedited and completed 3 days later. At present, he has no evidence of recurrent disease.
Case Report 2: Mr. M is a 62-year-old veteran who was referred to the ENT and Oncology Services in October 2017 for squamous cell carcinoma of base of tongue. He was first seen by ENT, discussed in MTB, then seen by KC and BA. Significant psychosocial issues were identified that could complicate his care, including homelessness and PTSD symptoms that directly impacted his ability to stay in VA housing and interact with the medical system. A multidisciplinary treatment plan was created to meet the veteran’s housing/ hygiene needs and provide interventions to assist him in managing PTSD symptoms enough to proceed through treatment. The veteran was able to complete treatment, has no evidence of recurrent disease, and has returned to his goal of hiking the Pacific Crest.
Background: Multidisciplinary tumor boards (MTBs) have been shown to positively impact the assessment and treatment of cancer patients (Pillay et al, 2016) and increase referrals to specialty services present at the meetings (eg genetic testing in breast cancer, Cohen et al, 2016). However, no research to date has explored the impact of involvement of psychosocial providers on MTBs. The following two cases are presented as examples of multidisciplinary cancer care that was facilitated by psychology/social work involvement in the Head and Neck Cancer MTB at VAPAHCS.
Case Report 1: Mr. T is an 86-year-old veteran who was referred to the Oncology and ENT services in May 2017 for a recurrent squamous cell carcinoma in the neck, presumably from prior lip primary. The patient evaluated by Oncology, KC, and ENT who recommended surgical resection. The veteran consented but later cancelled his surgery due to beliefs that God would cure him. The MTB reviewed his case, and the veteran agreed to return for a visit to the Oncology clinic. SD met with the veteran first, and then accompanied him to a meeting with the Oncologist who arranged a same day appointment with an ENT surgeon and an anesthesiologist. SD integrated the veteran’s belief systems (eg, that God would cure his cancer) to help facilitate his decisions. The veteran’s surgery was expedited and completed 3 days later. At present, he has no evidence of recurrent disease.
Case Report 2: Mr. M is a 62-year-old veteran who was referred to the ENT and Oncology Services in October 2017 for squamous cell carcinoma of base of tongue. He was first seen by ENT, discussed in MTB, then seen by KC and BA. Significant psychosocial issues were identified that could complicate his care, including homelessness and PTSD symptoms that directly impacted his ability to stay in VA housing and interact with the medical system. A multidisciplinary treatment plan was created to meet the veteran’s housing/ hygiene needs and provide interventions to assist him in managing PTSD symptoms enough to proceed through treatment. The veteran was able to complete treatment, has no evidence of recurrent disease, and has returned to his goal of hiking the Pacific Crest.
Background: Multidisciplinary tumor boards (MTBs) have been shown to positively impact the assessment and treatment of cancer patients (Pillay et al, 2016) and increase referrals to specialty services present at the meetings (eg genetic testing in breast cancer, Cohen et al, 2016). However, no research to date has explored the impact of involvement of psychosocial providers on MTBs. The following two cases are presented as examples of multidisciplinary cancer care that was facilitated by psychology/social work involvement in the Head and Neck Cancer MTB at VAPAHCS.
Case Report 1: Mr. T is an 86-year-old veteran who was referred to the Oncology and ENT services in May 2017 for a recurrent squamous cell carcinoma in the neck, presumably from prior lip primary. The patient evaluated by Oncology, KC, and ENT who recommended surgical resection. The veteran consented but later cancelled his surgery due to beliefs that God would cure him. The MTB reviewed his case, and the veteran agreed to return for a visit to the Oncology clinic. SD met with the veteran first, and then accompanied him to a meeting with the Oncologist who arranged a same day appointment with an ENT surgeon and an anesthesiologist. SD integrated the veteran’s belief systems (eg, that God would cure his cancer) to help facilitate his decisions. The veteran’s surgery was expedited and completed 3 days later. At present, he has no evidence of recurrent disease.
Case Report 2: Mr. M is a 62-year-old veteran who was referred to the ENT and Oncology Services in October 2017 for squamous cell carcinoma of base of tongue. He was first seen by ENT, discussed in MTB, then seen by KC and BA. Significant psychosocial issues were identified that could complicate his care, including homelessness and PTSD symptoms that directly impacted his ability to stay in VA housing and interact with the medical system. A multidisciplinary treatment plan was created to meet the veteran’s housing/ hygiene needs and provide interventions to assist him in managing PTSD symptoms enough to proceed through treatment. The veteran was able to complete treatment, has no evidence of recurrent disease, and has returned to his goal of hiking the Pacific Crest.
Evaluating Psychsocial Distress in Veterans and Their Caregivers at the Palo Alto VA
Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.
Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.
Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.
Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.
Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.
Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.
Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.
Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.
Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.
Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.
Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.
Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.
Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.
Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.
Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.
Implementing Psychosocial Distress Screening at the VA Palo Alto Health Care System: Lessons Learned and Future Directions
Purpose: To create and evaluate psychosocial distress screening procedures for patients diagnosed with cancer at the VA Palo Alto Health Care System (VAPAHCS).
Relevant Background/Problem: A program development and evaluation project was conducted at VAPAHCS in order to implement psychosocial distress screening according to the Cancer Program Standards (Standard 3.2) of the American College of Surgeon’s Commission on Cancer.
Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during one of their regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Data were abstracted from CPRS for distress screens conducted from January 2015-April 2016. The number of new cancer cases at VAPAHCS during the same time period was obtained from the cancer registry.
Data Analysis: The number of distress screens conducted was compared to cancer registry data of total new cases of cancer. Descriptive statistics were used to explore the level of distress and frequency of biopsychosocial symptoms endorsed by veterans in this sample.
Results: A total of 372 veterans completed distress screening during the program evaluation period. During the same time period, 920 veterans were newly diagnosed with cancer at VAPAHCS. Average level of distress was 3.3 (0 = no distress, 10 = extreme distress). Forty-one percent (n = 152) of veterans scored above the clinical cut-off for significant distress (4/10). The most commonly endorsed symptoms were fatigue (n = 97; 26.0%), worry (n = 93; 25.0%), pain (n = 92; 24.7%), sleep (n = 78; 21.0%), and skin dry/itchy (n = 78; 21.0%).
Implications: The discrepancy between number of new cases of cancer and number of distress screenings conducted during the program evaluation period suggests that modifications to current procedures are necessary to ensure that all cancer patients at VAPAHCS are screened for distress. Over 40% of veterans screened endorsed clinically significant levels of distress and over 20% of veterans endorsed problems with fatigue, worry, pain, sleep and/or skin issues. Future directions for care include introducing psychosocial interventions in the oncology clinic to reduce distress and cope with commonly reported symptoms/side effects.
Purpose: To create and evaluate psychosocial distress screening procedures for patients diagnosed with cancer at the VA Palo Alto Health Care System (VAPAHCS).
Relevant Background/Problem: A program development and evaluation project was conducted at VAPAHCS in order to implement psychosocial distress screening according to the Cancer Program Standards (Standard 3.2) of the American College of Surgeon’s Commission on Cancer.
Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during one of their regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Data were abstracted from CPRS for distress screens conducted from January 2015-April 2016. The number of new cancer cases at VAPAHCS during the same time period was obtained from the cancer registry.
Data Analysis: The number of distress screens conducted was compared to cancer registry data of total new cases of cancer. Descriptive statistics were used to explore the level of distress and frequency of biopsychosocial symptoms endorsed by veterans in this sample.
Results: A total of 372 veterans completed distress screening during the program evaluation period. During the same time period, 920 veterans were newly diagnosed with cancer at VAPAHCS. Average level of distress was 3.3 (0 = no distress, 10 = extreme distress). Forty-one percent (n = 152) of veterans scored above the clinical cut-off for significant distress (4/10). The most commonly endorsed symptoms were fatigue (n = 97; 26.0%), worry (n = 93; 25.0%), pain (n = 92; 24.7%), sleep (n = 78; 21.0%), and skin dry/itchy (n = 78; 21.0%).
Implications: The discrepancy between number of new cases of cancer and number of distress screenings conducted during the program evaluation period suggests that modifications to current procedures are necessary to ensure that all cancer patients at VAPAHCS are screened for distress. Over 40% of veterans screened endorsed clinically significant levels of distress and over 20% of veterans endorsed problems with fatigue, worry, pain, sleep and/or skin issues. Future directions for care include introducing psychosocial interventions in the oncology clinic to reduce distress and cope with commonly reported symptoms/side effects.
Purpose: To create and evaluate psychosocial distress screening procedures for patients diagnosed with cancer at the VA Palo Alto Health Care System (VAPAHCS).
Relevant Background/Problem: A program development and evaluation project was conducted at VAPAHCS in order to implement psychosocial distress screening according to the Cancer Program Standards (Standard 3.2) of the American College of Surgeon’s Commission on Cancer.
Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during one of their regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Data were abstracted from CPRS for distress screens conducted from January 2015-April 2016. The number of new cancer cases at VAPAHCS during the same time period was obtained from the cancer registry.
Data Analysis: The number of distress screens conducted was compared to cancer registry data of total new cases of cancer. Descriptive statistics were used to explore the level of distress and frequency of biopsychosocial symptoms endorsed by veterans in this sample.
Results: A total of 372 veterans completed distress screening during the program evaluation period. During the same time period, 920 veterans were newly diagnosed with cancer at VAPAHCS. Average level of distress was 3.3 (0 = no distress, 10 = extreme distress). Forty-one percent (n = 152) of veterans scored above the clinical cut-off for significant distress (4/10). The most commonly endorsed symptoms were fatigue (n = 97; 26.0%), worry (n = 93; 25.0%), pain (n = 92; 24.7%), sleep (n = 78; 21.0%), and skin dry/itchy (n = 78; 21.0%).
Implications: The discrepancy between number of new cases of cancer and number of distress screenings conducted during the program evaluation period suggests that modifications to current procedures are necessary to ensure that all cancer patients at VAPAHCS are screened for distress. Over 40% of veterans screened endorsed clinically significant levels of distress and over 20% of veterans endorsed problems with fatigue, worry, pain, sleep and/or skin issues. Future directions for care include introducing psychosocial interventions in the oncology clinic to reduce distress and cope with commonly reported symptoms/side effects.