There are a lot of studies on older cancer patients’ distress level, mainly during the course of chemotherapy and at the end of life. However, there are not a lot of studies on the distress that they have before undergoing cancer surgery. There are a lot of important issues to realise at that time: one is these are older patients, they have their own frailty and issues, they are diagnosed with cancer, the family is going through a lot of stress. There are a lot of unknowns for them which may create a lot of distress for them. Distress has shown to be correlated with their quality of life, their perception of quality of care that they receive and their outcomes. So my study looked at their distress level before undergoing cancer surgery.
Were there any successful interventions you found to change behaviour?
Guidelines suggest that these patients with a high level of distress should be referred to social workers, psychologists or many times there is an issue with just lack of information about their surgery and their outcome. So we try to implement that stuff – refer patients to social workers, mental health specialists or just educate them about their surgery and their surgery outcome.
Are oncologists looking more into patient histories for signs of distress?
What we’ve found is actually, number one, more than half of patients have a high level of distress before undergoing surgery. The second thing is that their distress is correlated with their functional status – how fit they are. The third thing is those who are depressed are more likely to have a high level of distress before surgery so definitely those who are depressed or have a history of anxiety might have a higher level of distress but that’s not all the information. As I said, distress correlates with unmet needs so the more needs you have the more likely that you have needs that are not answered and because of that you have a high level of distress.
What recommendations would you give based on your findings?
At least based on our experience and based on our data it’s very important for older cancer patients and their families to seek help and information from their surgeons or their primary care providers. Most of the time it’s just about knowing what they should expect, how long they are going to stay in the hospital, how functional they are going to be after surgery. At times cancer diagnosis is a stressful event so many patients and their families rush to the surgery without knowing what to expect, so taking some time, at least for a day or so, figuring out what questions they should ask and get the proper information is going to be a stress relieving intervention for many of them. At the end I do think that I have to emphasise that patients and families should have all the information that they feel is necessary for them. Don’t be shy to ask those questions, they have every right to do so. It’s very important to get that information before proceeding with surgery because after surgery it may create more stress if they haven’t thought about those things. One of the most important things is about the functional recovery – do they need additional help at home after surgery? Who is going to deliver that care, is it the family, is it home help aides? Those things are going to help them with their distress level and hopefully will lead to better outcomes.