Chwick K

Background: Multidisciplinary tumor boards (MTBs) have been shown to positively impact the assessment and treatment of cancer patients (Pillay et al, 2016) and increase referrals to specialty services present at the meetings (eg genetic testing in breast cancer, Cohen et al, 2016). However, no research to date has explored the impact of involvement of psychosocial providers on MTBs. The following two cases are presented as examples of multidisciplinary cancer care that was facilitated by psychology/social work involvement in the Head and Neck Cancer MTB at VAPAHCS.

Case Report 1: Mr. T is an 86-year-old veteran who was referred to the Oncology and ENT services in May 2017 for a recurrent squamous cell carcinoma in the neck, presumably from prior lip primary. The patient evaluated by Oncology, KC, and ENT who recommended surgical resection. The veteran consented but later cancelled his surgery due to beliefs that God would cure him. The MTB reviewed his case, and the veteran agreed to return for a visit to the Oncology clinic. SD met with the veteran first, and then accompanied him to a meeting with the Oncologist who arranged a same day appointment with an ENT surgeon and an anesthesiologist. SD integrated the veteran’s belief systems (eg, that God would cure his cancer) to help facilitate his decisions. The veteran’s surgery was expedited and completed 3 days later. At present, he has no evidence of recurrent disease.

Case Report 2: Mr. M is a 62-year-old veteran who was referred to the ENT and Oncology Services in October 2017 for squamous cell carcinoma of base of tongue. He was first seen by ENT, discussed in MTB, then seen by KC and BA. Significant psychosocial issues were identified that could complicate his care, including homelessness and PTSD symptoms that directly impacted his ability to stay in VA housing and interact with the medical system. A multidisciplinary treatment plan was created to meet the veteran’s housing/ hygiene needs and provide interventions to assist him in managing PTSD symptoms enough to proceed through treatment. The veteran was able to complete treatment, has no evidence of recurrent disease, and has returned to his goal of hiking the Pacific Crest.

Background: Multidisciplinary tumor boards (MTBs) have been shown to positively impact the assessment and treatment of cancer patients (Pillay et al, 2016) and increase referrals to specialty services present at the meetings (eg genetic testing in breast cancer, Cohen et al, 2016). However, no research to date has explored the impact of involvement of psychosocial providers on MTBs. The following two cases are presented as examples of multidisciplinary cancer care that was facilitated by psychology/social work involvement in the Head and Neck Cancer MTB at VAPAHCS.

Case Report 1: Mr. T is an 86-year-old veteran who was referred to the Oncology and ENT services in May 2017 for a recurrent squamous cell carcinoma in the neck, presumably from prior lip primary. The patient evaluated by Oncology, KC, and ENT who recommended surgical resection. The veteran consented but later cancelled his surgery due to beliefs that God would cure him. The MTB reviewed his case, and the veteran agreed to return for a visit to the Oncology clinic. SD met with the veteran first, and then accompanied him to a meeting with the Oncologist who arranged a same day appointment with an ENT surgeon and an anesthesiologist. SD integrated the veteran’s belief systems (eg, that God would cure his cancer) to help facilitate his decisions. The veteran’s surgery was expedited and completed 3 days later. At present, he has no evidence of recurrent disease.

Case Report 2: Mr. M is a 62-year-old veteran who was referred to the ENT and Oncology Services in October 2017 for squamous cell carcinoma of base of tongue. He was first seen by ENT, discussed in MTB, then seen by KC and BA. Significant psychosocial issues were identified that could complicate his care, including homelessness and PTSD symptoms that directly impacted his ability to stay in VA housing and interact with the medical system. A multidisciplinary treatment plan was created to meet the veteran’s housing/ hygiene needs and provide interventions to assist him in managing PTSD symptoms enough to proceed through treatment. The veteran was able to complete treatment, has no evidence of recurrent disease, and has returned to his goal of hiking the Pacific Crest.

Background: Multidisciplinary tumor boards (MTBs) have been shown to positively impact the assessment and treatment of cancer patients (Pillay et al, 2016) and increase referrals to specialty services present at the meetings (eg genetic testing in breast cancer, Cohen et al, 2016). However, no research to date has explored the impact of involvement of psychosocial providers on MTBs. The following two cases are presented as examples of multidisciplinary cancer care that was facilitated by psychology/social work involvement in the Head and Neck Cancer MTB at VAPAHCS.

Case Report 1: Mr. T is an 86-year-old veteran who was referred to the Oncology and ENT services in May 2017 for a recurrent squamous cell carcinoma in the neck, presumably from prior lip primary. The patient evaluated by Oncology, KC, and ENT who recommended surgical resection. The veteran consented but later cancelled his surgery due to beliefs that God would cure him. The MTB reviewed his case, and the veteran agreed to return for a visit to the Oncology clinic. SD met with the veteran first, and then accompanied him to a meeting with the Oncologist who arranged a same day appointment with an ENT surgeon and an anesthesiologist. SD integrated the veteran’s belief systems (eg, that God would cure his cancer) to help facilitate his decisions. The veteran’s surgery was expedited and completed 3 days later. At present, he has no evidence of recurrent disease.

Case Report 2: Mr. M is a 62-year-old veteran who was referred to the ENT and Oncology Services in October 2017 for squamous cell carcinoma of base of tongue. He was first seen by ENT, discussed in MTB, then seen by KC and BA. Significant psychosocial issues were identified that could complicate his care, including homelessness and PTSD symptoms that directly impacted his ability to stay in VA housing and interact with the medical system. A multidisciplinary treatment plan was created to meet the veteran’s housing/ hygiene needs and provide interventions to assist him in managing PTSD symptoms enough to proceed through treatment. The veteran was able to complete treatment, has no evidence of recurrent disease, and has returned to his goal of hiking the Pacific Crest.

Purpose: This project was created to improve prostate cancer education at VA Palo Alto Health Care System (VAPAHCS) and to explore Veterans’ knowledge about their diagnosis and its treatment. Prostate cancer is the most commonly diagnosed form of cancer in the VA and makes up one-third of all cancer cases in Veterans. Clinical experiences in our outpatient Urology-Oncology clinic suggested that Veterans may benefit from additional information about tumor stages, risk factors, and treatment options. Thus, a quality improvement project was conducted in order to measure baseline knowledge.

Methods: Veterans diagnosed with prostate cancer completed a survey to determine baseline knowledge. Surveys were conducted by a psychology trainee or social worker during regularly scheduled Urology-Oncology appointments. After completing the survey, Veterans were provided with written educational materials and had the option of watching a brief educational video on a tablet in their exam room.

Data Analysis: Descriptive statistics were used to analyze demographic information and to determine Veteran’s baseline levels of knowledge.

Results: 26 Veterans completed the survey between March and June 2018. 25 participants identified as male; one as a transgender female. Average age was 74 years, with a range from 63-88 years. 65% identified as white, 12% as black or African American, 12% Hispanic, and 11% unknown. Average time since diagnosis was 7.3 years, with a range from 0-21 years. 92% of Veterans knew what type of cancer they were diagnosed with, 62% were familiar with the different stages of prostate cancer, 54% were familiar with the risk factors for developing prostate cancer, 77% knew what their treatment options were, and 88% felt comfortable asking their doctor questions about their cancer and its treatment.

Implications: These results indicate that Veterans are well informed about the type of cancer they have been diagnosed with and are comfortable communicating with their doctor, but are less familiar with tumor stages, risk factors, and treatment options. This suggests that additional resources for prostate cancer education are warranted in our clinics. Future directions include the
development of additional educational programs within the VAPAHCS and incorporating assessment of Veteran knowledge during clinic visits.

Purpose: This project was created to improve prostate cancer education at VA Palo Alto Health Care System (VAPAHCS) and to explore Veterans’ knowledge about their diagnosis and its treatment. Prostate cancer is the most commonly diagnosed form of cancer in the VA and makes up one-third of all cancer cases in Veterans. Clinical experiences in our outpatient Urology-Oncology clinic suggested that Veterans may benefit from additional information about tumor stages, risk factors, and treatment options. Thus, a quality improvement project was conducted in order to measure baseline knowledge.

Methods: Veterans diagnosed with prostate cancer completed a survey to determine baseline knowledge. Surveys were conducted by a psychology trainee or social worker during regularly scheduled Urology-Oncology appointments. After completing the survey, Veterans were provided with written educational materials and had the option of watching a brief educational video on a tablet in their exam room.

Data Analysis: Descriptive statistics were used to analyze demographic information and to determine Veteran’s baseline levels of knowledge.

Results: 26 Veterans completed the survey between March and June 2018. 25 participants identified as male; one as a transgender female. Average age was 74 years, with a range from 63-88 years. 65% identified as white, 12% as black or African American, 12% Hispanic, and 11% unknown. Average time since diagnosis was 7.3 years, with a range from 0-21 years. 92% of Veterans knew what type of cancer they were diagnosed with, 62% were familiar with the different stages of prostate cancer, 54% were familiar with the risk factors for developing prostate cancer, 77% knew what their treatment options were, and 88% felt comfortable asking their doctor questions about their cancer and its treatment.

Implications: These results indicate that Veterans are well informed about the type of cancer they have been diagnosed with and are comfortable communicating with their doctor, but are less familiar with tumor stages, risk factors, and treatment options. This suggests that additional resources for prostate cancer education are warranted in our clinics. Future directions include the
development of additional educational programs within the VAPAHCS and incorporating assessment of Veteran knowledge during clinic visits.

Purpose: This project was created to improve prostate cancer education at VA Palo Alto Health Care System (VAPAHCS) and to explore Veterans’ knowledge about their diagnosis and its treatment. Prostate cancer is the most commonly diagnosed form of cancer in the VA and makes up one-third of all cancer cases in Veterans. Clinical experiences in our outpatient Urology-Oncology clinic suggested that Veterans may benefit from additional information about tumor stages, risk factors, and treatment options. Thus, a quality improvement project was conducted in order to measure baseline knowledge.

Methods: Veterans diagnosed with prostate cancer completed a survey to determine baseline knowledge. Surveys were conducted by a psychology trainee or social worker during regularly scheduled Urology-Oncology appointments. After completing the survey, Veterans were provided with written educational materials and had the option of watching a brief educational video on a tablet in their exam room.

Data Analysis: Descriptive statistics were used to analyze demographic information and to determine Veteran’s baseline levels of knowledge.

Results: 26 Veterans completed the survey between March and June 2018. 25 participants identified as male; one as a transgender female. Average age was 74 years, with a range from 63-88 years. 65% identified as white, 12% as black or African American, 12% Hispanic, and 11% unknown. Average time since diagnosis was 7.3 years, with a range from 0-21 years. 92% of Veterans knew what type of cancer they were diagnosed with, 62% were familiar with the different stages of prostate cancer, 54% were familiar with the risk factors for developing prostate cancer, 77% knew what their treatment options were, and 88% felt comfortable asking their doctor questions about their cancer and its treatment.

Implications: These results indicate that Veterans are well informed about the type of cancer they have been diagnosed with and are comfortable communicating with their doctor, but are less familiar with tumor stages, risk factors, and treatment options. This suggests that additional resources for prostate cancer education are warranted in our clinics. Future directions include the
development of additional educational programs within the VAPAHCS and incorporating assessment of Veteran knowledge during clinic visits.

Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.

Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.

Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.

Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.

Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.

Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.

Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.

Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.

Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.

Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.

Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.

Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.

Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.

Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.

Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.