Purpose
This study aimed to identify clinical, demographic and service-related predictors of psychological distress amongst outpatient chemotherapy patients, in order to more effectively screen for distress and provide additional support.
Methods
Data were obtained via survey and chart review of ambulatory chemotherapy patients at 3 tertiary hospitals in Perth, Western Australia. The DASS-21 was used to psychological distress. Regression analyses were used to assess the relationship between psychological distress and a range of patient demographic and treatment variables.
Results
Patients with a Karnofsky performance score ≤80 (p=0.001) and average waiting time >60 minutes (p=0.035) were at significantly increased risk of moderate-severe distress. Patients with a household income between $50-75,000 p.a. had a lower risk of distress (OR 0.074, 95% CI 0.01-0.66, p=0.02). In addition, patients with a household income >$100,000 p.a. had a lower risk of distress using the DASS-D subscale (OR 0.09, 95% CI 0.01-0.78, p=0.03). On sub-scale analysis, depression contributed more to overall distress than the anxiety or stress scores on the DASS-21.
Conclusions
We identified a Karnofsky score ≤80 as an identifier of patients at increased risk of psychological distress and likely to be in need of additional support. We also confirmed the psychological impact of service provision factors, such as long waiting times. A household income of $50-75,000p.a is protective against distress, relative to a baseline of <$25,000p.a. The identification of these potentially modifiable predictors of distress will assist in the screening of patients and implementation of appropriate support services.