Detecting and Treating Distress in Cancer Patients

Thomas V. Merluzzi

Professor
Director of Graduate Studies
Ph.D., University of Notre Dame

Dr. Merluzzi studies coping processes in people with cancer from the perspective of social learning theory and, in particular, self-efficacy theory. His recent work includes: the development and refinement of the Cancer Behavior Inventory, a widely used measure of self-efficacy for coping with cancer; the study of religious/spiritual coping in persons with cancer; and the refinement of the assessment of quality of life.

In partnership with Memorial Hospital of South Bend, we have undertaken a large-scale national research program to establish standards for distress screening that may be adopted nation-wide. We are developing a state-of-the-art Distress Screening System (DSS) to quickly detect distress, thus reducing patient burden and improving overall medical care. We are in the process of refining the DSS for use in clinical settings like the Memorial Hospital’s Regional Cancer Center. The goal would be to screen every patient and survivor for distress and make appropriate referrals to professionals, such as those at RiverBend Cancer Services or support groups. This screening and referral process will help patients and survivors manage their distress and improve their quality of life. Once detected, the treatment of distress associated with cancer is effective and reduces the cost of medical care.

For some people, the diagnosis and treatment of cancer can be accompanied by distress, which may be experienced as depression, anxiety or a stress reaction. About 30 percent of individuals diagnosed with cancer will have significant levels of distress at some point after diagnosis, with depression and anxiety as the most common emotional problems in adult cancer patients. The transition from active treatment to survivorship can be accompanied by uncertainty and worry about recurrence, as well as symptom management issues. In our research based on survivors, we have found that between 30 and 40 percent of survivors also report depression levels significant enough to warrant referral for counseling services. It is clear that many current patients and survivors manage distress without the assistance of a professional; however, others may experience lingering or persistent distress and may not have the coping skills necessary to overcome it in a timely manner.

Untreated depression, anxiety and stress can result in a number of negative health consequences. Patients who are distressed are more likely to report difficulties adjusting to their illness as well as impaired quality of life. Distress has also been associated with negative health outcomes, including increased health-care costs, lower compliance with medical treatments, longer hospitalizations, lower levels of satisfaction with care and greater dropout rates in clinical trials. In addition, failing to address psychological distress increases the likelihood that patients will seek care at emergency services and are likely to require more extended care. Furthermore, research has established connections between depression/anxiety and impairment of the immune system, which may impact disease progression and treatment recovery.