P58: A screening study of distress levels in patients attending a skin cancer clinic

O. Tummon, O. Costigan, A. Moloney, A. Lally and B. Moriarty

The Charles Centre for Dermatology, St. Vincent's University Hospital, Dublin, Ireland

Cancer distress is common, unpleasant and interferes with the ability to cope with disease and treatment. The literature on cancer distress in patients with skin cancer is sparse. The aim of this study was to screen for cancer distress in patients attending the adult skin cancer service in our academic institution. Consecutive patients completed the Distress Thermometer (DT), a screening tool for measuring distress recommended for use at every cancer outpatient visit by the National Cancer Comprehensive Network (NCCN), on arrival for their consultation. The DT measures distress on a Likert-type scale (0–10) and includes a 26-item questionnaire about practical, family, emotional, spiritual and physical problems. In total, 122 patients attending melanoma, keratinocyte cancer or rapid-access skin cancer clinics over a 4-week period were included in the study. The median age was 64 years (range 16–93). Sixty per cent (n = 74) were female. Fifty-nine per cent (n = 72) of patients reported distress, with 24·5% (n = 30) reporting a DT score of ≥4, indicating moderate-to-severe distress. From the problem list, 34·4% (n = 42) reported emotional problems, with ‘worry’ identified by 88%. Fifty-four per cent (n = 67) of patients reported having physical problems, including with sleep in 22·9% (n = 28), dry/itchy skin in 21·3% (n = 26) and fatigue in 16·4% (n = 20). Distress was reported by patients in all three clinic cohorts, with the highest results seen in patients with melanoma (mean DT score 3·2; range 0–9). Patients with keratinocyte cancers reported mean DT scores of 2·0 (range 0–8). A relationship between cancer subtype, cancer stage, disfiguring surgical treatment, systemic treatment, number of skin cancers or time (months) since most recent cancer diagnosis was not identified. Patients attending the rapid-access skin cancer clinic also reported distress (mean DT score 2·3; range 0–9). We report cancer distress as measured by the NCCN DT screening tool in patients attending our melanoma, keratinocyte cancer and rapid-access skin cancer services. The DT scores reported by patients with an established cancer diagnosis in this study are in keeping with the literature on patients with related diseases (uveal melanoma, n = 1; and head and neck cancer, n = 2). Patients attending for rapid-access review reported higher-than-expected DT scores, possibly reflecting anticipatory distress resulting from referral. The Dermatology Life Quality Index is used for patients with inflammatory skin conditions; however, there is no routinely used, established or published measure of psychosocial well-being in patients with skin cancer. DT is a validated, brief and easily interpretable tool. DT scores reported here suggest an unmet need and will allow us to advocate and plan appropriate support for this patient population.