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?:abstract
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Background: According to the Centers for Disease Control and Prevention, COVID-19 has affected more than 5,119,711 patients with more than 163,651 confirmed deaths reported. The mass media coverage and widespread eruption of illnesses have been associated with adverse mental health outcomes.1 Cancer patients represent an already-compromised population with elevated levels of anxiety and distress; the introduction of the COVID-19 pandemic places this vulnerable group at an even higher risk for mental health consequences. The purpose of this quality improvement initiative was to identify lung cancer patients in our care who demonstrated increased levels of anxiety and distress directly related to the COVID-19 pandemic and to facilitate the acquisition of appropriate care to address their mental health needs. This initiative was designed to aid in the reduction of stress and anxiety in an already burdened population. Methods: The sample included 441 patients undergoing treatment for or surveillance of lung cancer who were screened from April 2020 to July 2020 through the Lung Cancer Evaluation Center. Using the National Comprehensive Cancer Network (NCCN) Distress Thermometer, patients were called and asked a series of questions regarding their distress levels in relation to the COVID-19 pandemic. The NCCN tool uses a numeric scale from 0 to 10 to quantify level of distress, with 0 representing no distress and 10 indicating severe distress. Any patient scoring a 6 or greater was referred to the cancer center social worker. The social worker evaluated the patients\' needs and formulated a plan. Any patient who reported a distress level between 3 and 5 was counseled by the nurse practitioner to evaluate further needs. Patients reported reasons for distress as fear of delayed testing, contracting the virus, and changes in their lifestyle (not seeing family, isolation, etc.). Results: We found that screening all patients during the pandemic yielded a higher than normal percentage of individuals who were in need of some level of mental health services. Cancer patients, particularly lung cancer patients, have increased fear due to the respiratory symptoms of COVID-19. After completion of this quality improvement initiative, we have incorporated distress assessment and triage protocols into our practice for all patients. Importance and Implications: Patients with underlying medical conditions including cancer know that they are at increased risk of complications from the COVID-19 virus. This may cause them increased anxiety, distress, and fear. Screening this population with phone calls can effectively identify patients at risk, and with the implementation of this initiative, we can ensure that those who feel isolated or experience heightened levels of distress receive the appropriate care they need.
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