Early incorporation of a distress screening tool into nurse-led oncology case management improved the rate of referrals to supportive services for patients with cancer receiving active treatment, according to results of a study published in Professional Case Management.1

Previous research has shown that the biological, psychological, and social needs of oncology patients are often unmet. To facilitate assessment of some of these needs, the National Comprehensive Cancer Network (NCCN) has developed Distress Management clinical practice guidelines that include a validated distress screening tool, the Distress Thermometer and Problem List for Patients.2

In this pilot retrospective, matched case-control study of patients enrolled in a large commercial health plan, the potential impact of early incorporation of the NCCN distress screening tool into the standard oncology telephone interviews conducted by oncology nurse case managers was assessed. The main purpose of the study was to determine whether referrals to available resources were increased in those patients screened for distress using the NCCN tool compared with matched controls.  

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Of the 317 patients included in the distress screening group, all had received early screening with the NCCN tool as part of case management. A group of 2176 matched control patients, selected based on gender, age, and primary diagnosis, received standard case management only.

A key finding from this study was that the rate of referral to resources, including access to behavioral health care, a social worker, employee assistance, healthy foods, transportation, and financial assistance programs, was 66% and 50% (χ2P <.001) in the patients who did or did not receive distress screening, respectively. Patients with severe distress as assessed by the NCCN tool had the highest number of reported problems and received the most referrals.

In their concluding statements, the study authors noted that “our finding of a statistically significant increase in referrals and number of problems identified was likely accounted for by a reduction in time spent on the telephone to identify and prioritize problems causing distress including practical problems such as childcare, housing, insurance/financial problems, transportation, work/school, and treatment decisions.”


  1. Swanson AJ, Castel LD, McKenna PA, Shen YA, Sagar B. Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a guidepost for telephonic oncology case management. Prof Case Manag. 2019;24(3):148-154.
  2. National Comprehensive Cancer Network (NCCN) Distress Management Guidelines V.3.2019. https://www.nccn.org/professionals/physician_gls/pdf/distress.pdf. Accessed May 3, 2019.

This article originally appeared on Oncology Nurse Advisor