Distress Screening: Making the Fifth Vital Sign Integral to Oncology Care

This episode of the collaborative podcast between Oncology on the Go and the American Psychosocial Oncology Society, hosted by Daniel C. McFarland, DO, features Michelle B. Riba, MD, and focuses on integrating psychosocial care into oncology for clinicians.

The discussion emphasizes that psychosocial issues profoundly affect both quality of life and cancer-related outcomes, making their assessment an integral part of care, not merely ancillary. The distress thermometer was developed by the NCCN in the late 1990s as a scale from 0 to 10, dubbed the fifth vital sign. The term distress was chosen over psychiatric labels to capture the wide array of patient concerns, including pain, fatigue, sleep, and spiritual, practical, and family issues.

Distress screening is now mandated at regular appointments in all cancer centers in the US. Clinicians are encouraged to screen for more specific issues such as depression (linked to poor adherence and survival), anxiety (which can impede treatment adherence), and substance use. Oncologists are the doctors most able to consider a patient's totality of symptoms, and their role is integral to supporting psychosocial referrals.

To address the practical delivery of care, the collaborative care model is being advocated as a public health, population-based approach. Key components include:

• Use of a standardized screening tool
• Management by a dedicated care manager
• Weekly consultation between the care manager and a consultant psychiatrist for triage and treatment advice

The model allows oncologists to bill for care and learn more about these issues while ensuring patients receive evidence-based treatments. The clinicians conclude that fundamentally, mental health needs to be aligned alongside cancer care.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY. Riba is director of the PsychOncology Program, a clinical professor, and the associate chair for integrated medical and psychiatric services in the Department of Psychiatry at the University of Michigan Rogel Cancer Center as well as psycho-oncology editorial advisory board member for the journal ONCOLOGY.