K. J. Lafaro1, A. Li2, C. J. LaRocca1, J. Rodriguez3, K. Clark3, M. Lozcalzo3, F. L. Wong2, S. Warner1 1City Of Hope National Medical Center,Department Of Surgery,Duarte, CA, USA 2City Of Hope National Medical Center,Department Of Population Sciences,Duarte, CA, USA 3City Of Hope National Medical Center,Department Of Supportive Care Medicine,Duarte, CA, USA
Introduction: The diagnosis and treatment of cancer can cause patients significant psychological distress which can negatively impact their cancer treatment morbidity, recovery, and survival. Multiple factors may place patients at increased risk for psychological distress. Programs that identify these high risk patients and pre-emptively intervene may improve care and outcomes. Herein, we investigate the association of biopsychosocial factors with psychological distress of patients with gastrointestinal malignancies.
Methods: A validated forty-eight item electronic distress screen was administered to new patients in the medical and surgical oncology clinics of a large cancer center from 2009-2015. Responses were recorded on a five-point Likert scale from 1, indicating no problem, to 5 indicating a very severe problem. Univariate and multivariate logistic regression analyses were performed to analyze factors that impacted the psychological distress status of patients.
Results:A total of 1027 patients participated in biopsychosocial screening at a single institution from 2009-2015. The majority of patients had either colorectal (50%) or hepatobiliary (31%) malignancies. The median age at screening was 63. 48% of patients were female and 61% were Caucasian. Half of patients had at least a college degree. On univariate analysis, not having a partner (OR 0.67, 95%CI 0.49, 0.93, p=0.02), income <$40,000 (OR 0.52, 95%CI 0.36, 0.76, p=0.01) and tobacco use (OR 0.7, 95%CI0.52-0.93, p=0.01) were significantly associated with an increased level of overall psychological distress. Obesity was specifically associated with an increased risk of feeling anxious and fearful (OR 0.55, 95%CI 0.34, 0.87, p<0.001). However, age, gender, race, non-English primary language and level of education were not associated with increased psychological distress. On multivariate analysis, not being partnered, income <$40,000 and obesity remained significantly associated with increased psychological distress, fearfulness and anxiety (p<0.05).
Conclusion: Psychological distress can have a significant impact on cancer care and patient survival. It is feasible to identify GI cancer patients at high risk for psychological distress including those who are not married, obese or have incomes <$40,000. Identifying these patients will allow for early intervention and potentially improved cancer recovery and survival.