P64: The National Comprehensive Cancer Network distress thermometer as a screening tool for psychological and social distress in patients with keratinocyte skin cancer

Aoife Granahan,¹ Olga Tummons,¹ Aoife Maloney,¹ Aoife Lally^1,2 and Bláithín Moriarty^1,2

¹Dermatology Department, St. Vincent’s University Hospital, Dublin, Ireland; and ²Charles Centre of Dermatology & SVHG Strategic Skin Cancer Network, Dublin, Ireland

Psychological distress is experienced by many patients with cancer and can adversely affect quality of life and cancer care. It is notably under-recognized and under-reported in skin cancer medicine. In 1999, the National Comprehensive Cancer Network (NCCN) advised routine screening for distress in all patients with cancer and introduced the distress thermometer (DT) as a simple, effective tool to measure this. The DT is a self-reporting visual analogue scale that rates patients’ levels of distress from 0 (no distress) to 10 (severe distress). The primary objective of this study was to evaluate the degree of psychological distress in patients attending the keratinocyte cancer (KC) clinic, and to analyse the relationship between distress levels and sociodemographic parameters. Consecutive patients attending KC clinics over a 12-month period (November 2019–November 2020) were asked to complete the NCCN DT score. Additional demographic and clinical datasets were obtained from patients’ medical records. In total, 310 [158 females (58%)] patients were recruited (mean age 63 years; range 17–100). The mean (SD) DT score (DTS) was 2.5 (2.5). The DTS for new patients referred to the KC clinic was 2.6 [n = 152 (49%)], 2.4 [n = 158 (51%)] for follow-up patients and 4.4 [n = 11 (4%)] for patients attending for results. Patients with no history of skin cancer accounted for 51% (n = 157) of attendees with a mean DTS of 1.2, while patients with one or more skin cancers [n = 153 (49%)] reported a significantly higher level of distress (mean DTS of 2.5). Within this cohort, patients with one pervious skin cancer recorded the highest level of distress (mean DTS of 3.4). From the full dataset, more than one-third of patients [n = 104 (34%)] documented major distress with a DTS > 4, of which 62% (n = 64) were female. In this cohort, the highest distress levels were again noted in patients with previous history of skin cancer, with a mean DTS of 6.1 vs. a DTS of 5.3 in those with no history of skin cancer. There was a strong correlation between high DTS (DTS > 4) and practical problems, especially at work, family (dealing with partner), physical problems like pain, fatigue and concerns with memory/concentration, as well as self-reported emotional sources of distress. There was no association with higher distress levels and age or sex. Psychological distress has been extensively studied in patients with malignant melanoma as a well-established association with delayed presentations, reduced adherence to treatment regimens, lower quality of life and increased rates of melanoma recurrence. However, there is a paucity of research analysing distress in the KC population. In this study, we report a concerning level of psychological and social distress in patients with KC. We outline the effective use of the NCCN DTS as an initial measure to help identify patients who may benefit from further psychosocial support.