Of the 1,000 oncologists contacted, nine e-mails or letters were returned because of invalid addresses, 24 respondents declined participation, and two surveys were returned after the survey closed. Of the remaining sample (N=965), 448 responded (46%). There were 189 online responses and 259 mail responses, with no differences in practice settings between the online and mail respondents. Demographic characteristics of respondents are fairly representative of the ASCO membership (see ).
Characteristics of oncologists responding to a survey about their management of psychosocial distress
Respondents estimated that a mean±SD of 72%±23% of their patients experience psychosocial distress, with over one-third (38%±22%) having distress that warrants treatment. On a scale with possible scores ranging from 1, never, to 5, very often, respondents identified the frequencies of various types of distress. Practical problems were most common (mean=3.74±.86), followed by emotional problems unrelated to illness (mean=3.63 ±.76), psychological coping with illness and treatment (mean=3.53±.90), employment issues (mean=3.46±.80), dealing with a partner (mean=2.92±.77), dealing with children (mean=2.80±.85), and spiritual concerns (mean=2.40±.80). In multivariate linear regression models, none of the practice variables was associated with either rates of observed distress or distress requiring treatment.
Almost all respondents (441 of 447, or 99%), reported referring patients to psychosocial services or starting psychiatric medications. Nearly half said they refer patients to psychosocial services only (212 of 447, or 47%), and an approximately equal number said they both refer patients and start medications (214 of 447, or 48%); a few reported starting medications only (15 of 447, or 3%).
Half (225 of 447, or 50%) reported having mental health services affiliated with their practice, which varied by treatment setting as follows: 92 of 122 (75%) in cancer centers, 15 of 31 (48%) in hospitals, and 111 of 284 (39%) in the community (p<.001). Affiliated mental health professionals included social workers (122 of 258, or 47%), psychologists (67 of 259, or 26%), psychiatrists (44 of 259, or 17%), and psychiatric nurse practitioners (21 of 259, or 8%). Availability of social workers and psychologists was associated with practice setting (p<.001 and p= .008, respectively), with greater availability in cancer centers.
The most common interventions reported were referrals to support groups (307 of 447, or 69%) and to social workers (287 of 447, or 64%). Over half (241 of 447, or 54%) reported referring distressed patients to psychiatrists. Oncologists who reported not having mental health services affiliated with their practice reported lower rates of referrals to both social workers (p<.001) and psychiatrists (p=.009). However, the oncologists estimated that only about half of their patients (mean=58%±27%) followed through with these referrals. Oncologists who had mental health services affiliated with their practices reported higher rates of follow-up in referrals compared with those without such services (p<.001).
Although almost half of the respondents reported starting their patients on a psychotropic medication regimen, there were no differences in practice variables between oncologists who reported prescribing and those who did not. Selective serotonin reuptake inhibitors (SSRIs) were commonly prescribed (204 of 229, or 89%), as were benzodiazepines (158 of 229, or 69%). Oncologists also reported prescribing tricyclics (66 of 229, or 29%), stimulants (53 of 229, or 23%), other antidepressants (45 of 229, or 20%), antipsychotics (21 of 229, or 9%), and anticonvulsants (five of 229, or 2%). The prescription of SSRIs was associated with having less than 20 years of experience (odds ratio=.80, 95% confidence interval=.68–.96 p=.015) but not with any other practice variable.