Distress and Care Utilization in Patients with Myeloproliferative Neoplasms.

Abstract

Introduction: Distress negatively affects cancer outcomes. The National Comprehensive Cancer Network (NCCN) recommends screening patients for distress by a self-reported scale (0-10) and referring those with scores ≥4 to supportive services (SSs). Little is known about the prevalence of distress and healthcare utilization in classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs): polycythemia vera (PV), essential thrombocythemia (ET), myelofibrosis (MF).

Methods: We retrospectively identified MPN patients at our center to measure the proportions of patients with distress ≥4 evaluated by a SS (chaplaincy, integrative oncology, palliative medicine, psychiatry, psychology, and social work [SW]) or had acute care utilization (ACU; ≥ 1 ED visit or hospitalization) within 6 months of electronic distress screening (EDS). We also obtained sociodemographic, disease characteristics, and symptom score data to stratify variables associated with distress.

Results: Among 141 patients (44 PV, 49 ET, and 48 MF), the median age was 63 years (range, 25-89). Most patients identified as female (62%), white (77%), and completed EDS within 3 months of diagnosis (55%). Of 75/141 (53%) who reported distress ≥4, only 25/75 (33%) were evaluated by SS, and 23/75 (31%) had ACU within 6 months of EDS. Patients with distress ≥4 evaluated by SS had significantly higher ACU (48% vs. 14%; p = 0.009). Distress was associated with higher symptom scores and more ED visits but not gender, race, ethnicity, diagnosis, relationship status, or insurance.

Conclusion: Despite consensus recommendations, most patients with distress ≥4 were not evaluated by SS. Future work should identify ways to better use patient-reported outcomes to promote early intervention.