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Observational Study
. 2018 Sep:4:1-10.
doi: 10.1200/JGO.17.00044.

Distress Management in Patients With Head and Neck Cancer Before Start of Palliative Chemotherapy: A Practical Approach

Vijay Patil  1 , Vanita Noronha  1 , Amit Joshi  1 , Jayita Deodhar  1 , Savita Goswami  1 , Santam Chakraborty  1 , Anant Ramaswamy  1 , Sachin Dhumal  1 , Chandrakanth M V  1 , Ashay Karpe  1 , Nikhil Pande  1 , Vikas Talreja  1 , Arun Chandrasekharan  1 , Siddharth Turkar  1 , Kumar Prabhash  1
Affiliations
Observational Study

Distress Management in Patients With Head and Neck Cancer Before Start of Palliative Chemotherapy: A Practical Approach

Vijay Patil et al. J Glob Oncol. 2018 Sep.

Abstract

Purpose: This study reports the incidence of distress, the factors associated with distress, and a practical strategy to resolve distress in patients with head and neck cancer who are starting palliative chemotherapy.

Methods: Adult patients with head and neck cancer planned for palliative chemotherapy underwent distress screening before the start of treatment as part of this single-arm prospective study. Patients who had a distress score > 3 on the National Comprehensive Cancer Network (NCCN) distress thermometer were counseled initially by the clinician. Those who continued to have high distress after the clinician-led counseling were referred to a clinical psychologist and were started on palliative chemotherapy. After counseling, distress was measured again. The relation between baseline distress and compliance was tested using Fisher's exact test.

Results: Two hundred patients were enrolled, and the number of patients with high distress was 89 (44.5% [95% CI, 37.8% to 51.4%]). The number of patients who had a decrease in distress after clinician-led counseling (n = 88) was 52 (59.1% [95% CI, 48.6% to 68.8%]) and after psychologist-led counseling (n = 32) was 24 (75.0% [95% CI, 57.6% to 72.2%]; P = .136). Compliance rates did not differ between the patients with or without a high level of distress at baseline (74.2% v 77.4%, P = .620).

Conclusion: The incidence of baseline distress is high in patients awaiting the start of palliative chemotherapy. It can be resolved in a substantial number of patients using the strategy of clinician-led counseling, with additional referral to a clinical psychologist as required. Patients with a greater number of emotional problems usually require psychologist-led counseling.

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