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Identifying – and helping – cancer patients in distress

This summer Gerard Blum was diagnosed with cancer at the base of his tongue. The experience, he says, made him aware of just how important it is to speak up – and reach out.

“I realized the need for honesty, and I recognized you need to ask for help,” says Gerard. IdentifyThat help is now being enhanced through the use of a screening for distress tool and its questionnaire.

Cancer patient navigators in seven of the nine health districts are using the tool, as well as the Head and Neck and Thoracic cancer clinics in Halifax. Several satellite clinics are also using the new tool, and the program is continuing to roll out across the province.

"Our vision is to improve care for cancer patients,” says Dr. Janice Howes, psychologist and Clinical Leader, Psychosocial Oncology for Cancer Care Nova Scotia. “If we ask people about their concerns, we will have a better understanding of their level of distress. Then we can help them cope and deal with their concerns.”

L-R: Karen Woodworth, Head and Neck Oncology Case Manager, Capital Health; Gerard Blum, patient

Earlier this year the Head and Neck Oncology Clinic in Halifax began using the tool with newly diagnosed patients, like Gerard. It was the first time this consistent tool and approach has been used in a practice setting.

“We always discuss concerns with patients, but the questionnaire helps paint a clearer picture and identifies issues that we may not have been aware of,” says Head and Neck Oncology Case Manager, Karen Woodworth. For example, many patients note on the questionnaire that they are worried about being a burden to others.”

The section of the questionnaire intended for patients is easy to complete, says Gerard. More importantly, he notes, “It’s eye opening. It helps you to understand what is bothering you. Then you can deal with it.”

For Gerard, who has also battled depression in the past, becoming empowered has taken him to a stage he never expected. Literally. As a way of dealing with his depression, and now cancer, Gerard is using stand-up comedy as a way to reach out to others and to deal with his disease.

“It’s very important to think positively and do what you need to do to get better,” says Gerard.

Screening for distress can help. “It gives us insight into what is bothering patients, and it sends an important message,” says Dr. Howes. “It lets patients know we want to help them with all their needs as they travel through the cancer journey.”

At present, the Screening for Distress Initiative is focused on ambulatory care, but this may expand to inpatients. “The goal is also to rescreen patients as they go through the cancer system,” says Marianne Arab, CCNS’s Manager of Supportive Care. “There are key times to rescreen. It’s about managing the patient’s distress, and following up and continuing to monitor how the patient is feeling and coping with their illness.”

As Gerard says, “When you understand what’s upsetting you – and you try to deal with it – you start feeling better about yourself. It’s part of your recovery.”

Screening for Distress is a national initiative, led by the Canadian Partnership Against Cancer, of which Cancer Care Nova Scotia is a part. Approximately 35% to 45% of cancer patients suffer significant distress at some point in their cancer experience, and the management of distress has now been identified as the sixth vital sign in cancer care. As well, it has recently become part of the accreditation standards for cancer centres in Canada.

This initiative has been made available as the result of a financial contribution from Health Canada, through the Canadian Partnership Against Cancer, and with support from Cancer Care Nova Scotia and the province’s district health authorities.