The Role of the Psychooncologist

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Screening for Distress Debate
Alex Mitchell www.twitter.com/_alexjmitchell Un
iversity of Leicester
www.psycho-oncology.info
ipos2013
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What are the sources of disagreement?
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• Areas of Disagreement
• How to screen (which tool)
• When to screen
• How often to screen
• Which screening population
• Who should screen
• Does screening work

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in short Should we screen at all?
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But what are the alternatives to screening?
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1. Diagnosis as usual (do nothing)
2. Enhanced diagnosis (clinician screen)
3. Screen everyone
4. Screen high risk (targeted screening)

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Comment Slide illustrates diagnostic accuracy
according to score on DT
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Lessons from primary care.
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Results disappointing Acceptability
overlooked Most are not depressed Many do not
want help Some are already Rx
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Screening in Cancer
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Missed diagnosisGP CNS Oncologists
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Screening tools (validity)
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Depression
Distress
Brief / ultra-short
Multi-domain
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Implementation evidence
Randomized Non-Randomized
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Q. What type of studies? Q. How many ve
studies? Q. What are the beneficial
outcomes? Q. What is the size of the effect?
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Implementation Reviews
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Implementation Studies

• 9 studies Distress gt Referral
• 6 studies gt Communication

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.this is getting complex. ..what
is the overall effect?
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Overall Effect of screening Baseline CARE
x with screening 10 (0-20)
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Overall Effect of screening Baseline CARE
x with screening 10 follow-up 10
treatment 10
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What is holding back screening success?
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BOTH. How Many Receive Ps Help? (n2557)
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Receiving Any treatment for Mental Health
12mo Service Use (NIH, 2002)
Maria Hewitt, Julia H. Rowland Mental Health
Service Use Among Adult Cancer Survivors
Analyses of the National Health Interview Survey
Journal of Clinical Oncology, Vol 20, Issue 23
(December), 2002 4581-4590
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Overall Effect of screening Baseline CARE x
35 with screening 10 (0-20)
follow-up 10 (0-20) treatment 10
(0-20)
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..So is screening successful or not?
.It depends
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Analogy How do we reduce speeding drivers?
US deaths 10,000
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Analogy
Aim is to reduce speed (and hence deaths) Not
simply to detect speeding!
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Aim is to reduce distress (improving QoL) Not
simply to detect distress!
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0. Summary
Screening can be ineffective or
effective Screening may be optional or mandated
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