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Utility of Routine Psychological Screening in the Childhood Cancer Survivor Clinic

Christopher Recklitis, Tara O’Leary, Lisa Diller

From the David B. Perini Jr. Quality of Life Clinic, The Dana-Farber Cancer Institute, Boston, MA.

Address reprint requests to Christopher J. Recklitis, PhD, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, email: christopher_recklitis{at}dfci.harvard.edu.

Purpose: This study examined the utility of routine psychologic screening in a childhood cancer survivor clinic by evaluating patient acceptance, comparing subjects’ symptoms to normative data, examining the utility of specific tests, and identifying risk factors associated with psychological distress.

Methods: During their annual clinic visit, 101 adult survivors of childhood cancer (median age, 25 years) completed the Symptom Checklist 90 Revised (SCL-90), as well as the Short Form 36 (SF-36), Beck Depression Inventory (BDI), and one additional suicide question. Psychological distress was operationally defined according to the published SCL-90 clinical case rule, classifying subjects with a consistent pattern of symptom elevations as clinical cases.

Results: The majority of subjects (80%) completed the screening in less than 30 minutes and reported little (15%) or no (84%) distress. Sixty-four percent believed it would help "very much" or "moderately" in getting to know them, and 35% thought it would help "slightly." On the SCL-90, 32 subjects (31.7%) had a positive screen, indicating significant psychological distress. All subjects with clinically significant symptoms on the BDI and SF-36 Mental Health Scale were cases on the SCL-90 (case-positive). Suicidal symptoms were reported in 13.9% of the sample, all of whom were SCL-90 cases. In a logistic regression model, subjects’ dissatisfaction with physical appearance, poor physical health, and treatment with cranial radiation were associated with psychological distress.

Conclusion: Results demonstrate that routine psychological screening can be successfully integrated into the cancer survivor clinic and may be effective in identifying those survivors with significant distress who require further evaluation.

Supported in part by grant no. T32 HS00063 from the Agency for Healthcare Research and Quality, United States Department of Health and Human Services, to the Harvard Pediatric Health Services Research Fellowship Program (C.R.), and by a grant from the Lance Armstrong Foundation (C.R.).

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