BALTIMOREMedical personnel are often "dreadful" at singling
out individuals facing mood disturbances, emotional issues, and practical
problems that can cause severe distress during cancer treatment, according
to Matthew Loscalzo, MSW, director of patient and family services and
co-director of oncology pain services at the Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins in Baltimore. A new screening and assessment
tool used at the onset of treatment, however, identifies the issues most
important to each individual patient and allows staff to promptly arrange
for needed services, he told an industry-sponsored symposium held in
conjunction with the Oncology Nursing Society annual meeting.
Developed at Hopkins, the pencil-and-paper checklist covers physical and
psychological symptoms as well as issues involving the patient’s
responsibilities and activities. It also forms the basis for the National
Comprehensive Cancer Network Distress Panel’s recommendations, Mr.
Patients using the instrument generally cite between 8 and 13 serious
problems, with fatigue, pain, and transportation topping the list. Other
common complaints include worry, anorexia, insomnia, and irritability, he
reported. Having specific information about the needs of individual patients
greatly aids nurses in helping patients manage their quality of life and
treatment plans, he added.
Obstacles to Reporting
Many obstacles prevent patients from volunteering information symptoms
and resource deficits that can affect not only their treatment but their
entire quality of life, Mr. Loscalzo continued. Prominent among these
obstacles are the desire to be a "good patient" and the belief
that such issues are "too trivial" to bring to professionals’
attention, he said. Low energy, which affects between 40% and 80% of
patients, also plays a role.
Because lack of energy is a symptom of both treatment-related fatigue and
depression, discerning its origin is vital to providing high-quality care to
the "whole person," Mr. Loscalzo said. The screening tool has
proven very useful in this regard, he added. By doing universal and
systematic screening and assessment of patients’ and families’ needsfacilitated
by the screening tooloncology nurses are "going to do the same thing
with fatigue as [they] did with pain," Mr. Loscalzo concluded.