Geerse, O.P., Hoekstra-Weebers, J., Stokroos, M.H., Burgerhof, J.G.M., Groen, H.J.M., Kerstjens, H.A.M., & Hiltermann, T.J.N. (2017). Structural distress screening and supportive care for patients with lung cancer on systemic therapy: A randomised controlled trial. European Journal of Cancer, 72, 37–45.

DOI Link

Study Purpose

To examine effects of routine distress screening and referral on patient’s mood, satisfaction, and quality of life

Intervention Characteristics/Basic Study Process

Patients were randomized to receive the routine screening or usual care. Study assessment were done at outpatient visits weeks 1, 7, 13, and 25 after study entry. Usual care involved medical care and psychosocial care by the physician; psychosocial care was not integrated and referrals for psychosocial care were based on physician judgment. There was no structural distress screening. In the screening group, patients completed the Distress Thermometer and Problem List at each clinic visit. For scores of 4 or greater, patients were offered referral to an appropriate provider.

Sample Characteristics

  • N = 195 entered, 111 at 25 weeks 
  • AGE: Mean = 61.6 years
  • MALES: 42.8%  
  • FEMALES: 48.2%
  • KEY DISEASE CHARACTERISTICS: Newly diagnosed with lung cancer, prior to treatment
  • OTHER KEY SAMPLE CHARACTERISTICS: The majority had stage IV disease. Baseline scores did not show clinically relevant anxiety or depression

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: Netherlands

Phase of Care and Clinical Applications

PHASE OF CARE: Active anti-tumor treatment

Study Design

RCT

Measurement Instruments/Methods

  • EORTC-QLQ-C30: Quality of life
  • EORTC-LC13: Symptoms specific to lung cancer
  • Hospital Anxiety and Depression Scale (HADS)
  • PSQIII: Depression
  • Charlston Comorbidity Index

Results

There were no differences between groups in study outcome results for quality of life, depression, or anxiety. There were no differences in hospitalizations or ED visits between groups.

Conclusions

Findings did not show that routine distress screening and provision of care based on screening had any effect.

Limitations

  • Risk of bias (no blinding)
  • Subject withdrawals ≥ 10%  
  • Other limitations/explanation: Use of referrals in both study groups is not discussed and results of distress screening are not provided.

Nursing Implications

This study did not show any significant differences in patient outcomes due to implementation of routine distress screening and associated supportive care referral.