Distress, the 6th Vital Sign of Cancer
Worldwide, the burden of Cancer continues to grow with an increasing number of new diagnosis and deaths each year. A significant proportion of individuals diagnosed with cancer across stages of the disease trajectory suffer social, emotional and psychological distress due to the stigma associated with cancer, as well as its diagnosis, treatment side-effects and survivorship issues. This makes it imperative that psychological distress be assessed on a regular basis to understand the reason, severity of the problem and to help individuals who are diagnosed with cancer.
What is Distress?
Distress is an unpleasant experience of a physical, mental, social or spiritual nature. It can make it difficult for someone to cope with having cancer, its symptoms, cancer directed treatment, treatment side effects and their survivorship. It can, as a result, affect the entire family. Distress impacts an individual across a range of experiences. It varies from mild to severe and includes intense feelings of sadness, fear and helplessness.
Everyone with cancer has some level of distress at any given point of time during the illness and its treatment. It is not only patients who are affected – their caregivers too experience distress during and after the course of illness. Moreover, distress extends along a continuum, ranging from common feelings of vulnerability, sadness, and fear to problems that can become disabling such as depression, anxiety, panic, social isolation, and existential and spiritual issues.
The 6th vital sign
Vital signs of body temperature, pulse or heart rate, blood pressure and respiratory rate are four physical vital signs that are routinely measured to best describe a person’s physical status. Pain has been designated as the 5th vital sign since it is a very common symptom in cancer and distress being highly prevalent in cancer has now been designated as the 6th vital sign.
40% of those diagnosed with cancer experience significant levels of distress. However, fewer than 10% of patients are actually identified and referred for appropriate psychosocial support. Screening for distress is important for every patient at the appropriate time to ensure adequate level of management which requires the expertise of health professionals.
When facing cancer emotional reactions are normal but they can become clinically significant when they interfere with the patients’ general functioning, with their cancer treatment or with their progress in cancer care. The clinical significance of distress can be influenced by many factors such as type of cancer, stage of cancer, type of treatment, individual characteristics such as patients’ personality and other factors such as social support and financial conditions. Psychological distress is considered to be common as patients with cancer move beyond their diagnosis and into intensive treatment.
Vulnerability to distress
Patients are vulnerable to distress at various stages of the disease trajectory, as cancer increases the risk of substantial and permanent physical impairment, disability and an inability to perform routine activities. The investigation period, determining the diagnosis, getting treatment and facing its side effects are the stages when patients’ vulnerability is high. Survivorship has it’s stressors too – with the constant fear of recurrence or relapse, making getting back to normalcy a challenge for many people surviving cancer.
Patients in distress tend to make extra visits to physicians and hospitals. Often, they seem to have trouble making decisions about treatment and adhering to the treatment. They often feel dissatisfied with their physicians and medical care when in distress.
Distress – Role of psycho-oncologist
Early diagnosis and availability of psycho-oncology services enhance treatment satisfaction and help patients cope with the emotions accompanying the illness and the treatment. It also helps in improving patient-physician communication, respect and trust. Additionally, psycho-oncology services are helpful in improving patients’ adherence to the treatment regimen, as well as working through survivorship issues. Most importantly it helps patients and their families manage their levels of distress by providing both supportive and therapeutic services to deal with the challenges that present in an effective manner. The goal of psycho-oncology support is to work towards an improvement in the quality of life of patients and their caregivers.
Cancer not only affects an individual but the entire family. Reducing levels of distress experienced by both the patient and his or her family and improving their mental health are important goals for psycho-oncologists. Regular screening for distress helps us understand the severity and specific areas of psychological concern and plan interventions for the same.