Integrating Mental Health Screenings Into Early Routine Cancer Care

The implementation of mental health screenings through patient-reported outcomes (PROs) and standardized assessment tools provides a streamlined approach to identifying psychological distress in oncology clinics without adding significant burden to clinical staff, according to Julian C. Hong, MD, MS. Standardized instruments, such as the NCCN Distress Thermometer and Patient Health Questionnaire (PHQ) scales, facilitate the identification of a diverse set of symptoms that correlate with new-onset mental health disorders (MHDs). These tools enable a simple metric to facilitate triage, which is critical given that specialized psycho-oncology teams often face demand that outpaces supply.

Clinical findings from a large-scale analysis of the University of California Health system underscore the necessity of these screening workflows, as 10.6% of patients with cancer developed a new MHD within 1 year of their diagnosis. The most prevalent conditions identified included generalized anxiety disorder in 43.0% of cases and major depressive disorder in 35.5%. Furthermore, the study demonstrated that early MHD was linked to an increased risk of all-cause mortality, particularly within the first 12 to 35 months following diagnosis (HR, 1.51; 95% CI, 1.47-1.56), highlighting the urgent need for early intervention and automated triage.

In an interview with CancerNetwork, Hong, associate professor of radiation oncology in the Baker Computational Health Sciences Institute at the University of California, San Francisco (UCSF), and head of Artificial Intelligence at UCSF Helen Diller Family Comprehensive Cancer Center, as well as an investigator on the trial, explained that a lot of routine screening is now facilitated through PROs, with many cancer clinics focusing on questionnaires oriented toward capturing psychological data. He noted that the NCCN Distress Thermometer is a quick questionnaire at its most basic level and that a simple 1-to-10 scale does a great job of identifying correlated factors. Hong emphasized that thinking about ways to streamline these processes in the oncology space is vital, particularly as clinicians look to deliver care at scale and address operational bottlenecks in specialized psychiatric referrals.

Transcript:

CancerNetwork: What are some practical ways to implement mental health screenings into routine workflows without overburdening the already-busy staff?

Hong: Certainly, a big part of things we work on [is] trying to come up with [ways to] improve detection in a way that fits well into the clinical workflows. We've done a better job of routinely screening for things over time. A lot of that is facilitated through patient-reported outcomes. At least in our cancer clinics, there's been a lot of work on trying to give people questionnaires that are oriented towards capturing this type of information. A classic one is the NCCN Distress Thermometer, which is, at its most basic level, a fairly quick questionnaire. We've done some work, even just with a number on a scale from [1 to] 10. It does a great job in identifying a diverse set of things that are correlated with it. That's a reasonably simple metric that can facilitate different forms of triage. The forms of triage are the hard part of that. Certainly, there are other screening instruments that are out there, the PHQ questionnaires, for instance, that are out there. And that's a big part of our work in the primary care space.

Thinking about ways to streamline that in the oncology space, there's a lot of work being done in that area. In general, as I mentioned earlier, with more psychiatrists who are focused on oncology, the demand outpaces the supply for these highly specialized teams, and trying to come up with ways to both help get people to them, but also to try to deliver that at scale and to be able to get people in. Those are some of the bottlenecks that are important for us to be thinking about operationally.

Reference

Ganjouei AA, Zack T, Friesner I, et al. Association of mental health disorders and all-cause mortality for patients with cancer: large-scale analysis of University of California Health System Data. Cancer. 2026;132(5):e70254. doi:10.1002/cncr.70254