Category IV: Psychosocial Support/Assessment

• D1. Reducing Breast Cancer–Related Distress and Barriers to Care through Susan G. Komen’s Telehealth Patient Navigation Model

D1 Reducing Breast Cancer–Related Distress and Barriers to Care through Susan G. Komen’s Telehealth Patient Navigation Model

Toni Lee, MHAc; Julie McMahon, MPH; Kristin Scheeler, MSSW, CAPSW, OSW-C; Shelby Lautner, PhD; Janet Okamoto, PhD

Susan G. Komen

Background: For 20 years, oncology professionals have regarded cancer-related distress as the “sixth vital sign.”¹ Komen’s Patient Care Center telehealth navigation program adapted the National Comprehensive Cancer Network (NCCN) Distress Management Thermometer^2,3 to assess and respond to cancer-related distress of those facing a breast cancer diagnosis.

Objective: By administering the NCCN distress thermometer at the onset and conclusion of care across 4 domains—financial/ practical, emotional, physical, and familial—Komen navigators sought to reduce cancer-related distress by addressing identified barriers and providing emotional support.

Methods: Komen patient navigators conduct distress screening using a modified NCCN distress thermometer (11-point scale where a higher score indicates higher levels of distress) at intake and repeated at major transitions in care, including changes in treatment modality, upstaging and disease progression, transition to palliative or end-of-life care, and/ or completion of treatment and closure of case.

During new client intake, patients rate the levels of distress they are experiencing across the 4 domains and navigators follow up with probing questions to identify barriers contributing to their distress. The navigator conducts this conversation over the phone, using active listening to ensure a patient-centered assessment of needs. The navigator chooses from recommended evidence-based interventions to address identified barriers, ranging from providing education and coaching to emotional support and linking to community-based resources and referral services. The intent is to obtain at least 2 measurements for each patient.

Results: Of those served by Komen’s Patient Care Center patient navigation program, 39% identified as Black or African American, 38% identified as Hispanic or Latino, and 19% identified as White. The average age of those served was 55 years, and 25% were living with metastatic breast cancer.

From April 1, 2023, through March 31, 2024 (Komen’s fiscal year), Komen navigators conducted at least 2 observations of distress for 257 individuals that could be compared for pre- and post-analysis. The average pre-navigation emotional, familial, financial, and physical distress scores were 6.58, 4.27, 8.10, and 5.63, respectively. Average post-navigation scores were 4.49 for emotional distress (a 19% decrease from pre-navigation), 2.98 for familial distress (a 12% decrease), 6.12 for financial distress (an 18% decrease), and 4.23 for physical distress (a 13% decrease).

Conclusion: Measuring distress in a telehealth navigation model has the potential to impact individuals who may be experiencing higher levels of distress and may be less likely to have access to navigation services. Across the 257 individuals with complete distress data, distress levels were decreased across all domains, with a most significant decrease in emotional distress.

Additionally, this model of navigation has the potential to offer personalized support to those in historically underserved communities.

Implementing distress level measurement can address barriers and effectively reduce cancer-related distress as a navigation outcome among patients with breast cancer.

References

1. Fradgley EA, Bultz BD, Kelly BJ, et al. Progress toward integrating distress as the sixth vital sign: a global snapshot of triumphs and tribulations in precision supportive care. J Psychosoc Oncol Res Pract. 2019;1(1):e2.
2. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Distress During Cancer Care. Accessed May 21, 2024. www.nccn.org/professionals/physician_gls/pdf/distress.pdf
3. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Patients. Distress During Cancer Care. Accessed May 21, 2024. www.nccn.org/patients/guidelines/content/PDF/distress-patient.pdf