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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0740

Beyond the distress thermometer: a framework for assessing social determinants of health in patients with serious mental illness and cancer

BEYOND THE DISTRESS THERMOMETER: A FRAMEWORK FOR SOCIAL DETERMINANTS OF HEALTH ASSESSMENT IN PATIENTS WITH SERIOUS MENTAL ILLNESS AND CANCER

A distress thermometer score of 0/10 in a patient with serious mental illness and cancer failed to reflect the psychosocial burden and barriers to care, prompting the proposal of a consultation-liaison psychiatry framework to complement screening.

The aim is to demonstrate that NCCN distress screening may not adequately reflect the psychosocial burden in cancer patients with serious mental illness (SMI) and to propose a consultation-liaison psychiatry framework to complement the distress thermometer. The method consists of a single psycho-oncology case report involving a discrepancy between the distress score and the clinical course, and the development of a conceptual framework based on this case. The case concerns a 52-year-old woman with chronic schizophrenia who was diagnosed with advanced hormone receptor-positive breast cancer after months of interrupted care and whose score on subjective distress thermometer screening was recorded as 0/10. During the course of care, despite documentation of a breast mass, imaging and biopsy were repeatedly deferred, and the diagnosis was established during a psychiatric crisis assessment (ER+/PR+/HER2 1+ inflammatory breast cancer, cT4dN1M0). After discharge, all outpatient oncology follow-up appointments were missed, continuity of care was disrupted by duplicate medical records and incomplete pathology information, and the disease subsequently presented at an advanced stage with pleural effusion, ascites, bilateral masses, and extensive bone lesions. Social determinant-related barriers accompanying these stages included active psychosis, housing instability, language access and the need for an interpreter, issues of decision-making capacity and trust, lack of a landline telephone, transportation and cost, food and housing insecurity, fragmented records, and the absence of a single team taking ownership of the care process. The proposed framework supplements the question “How much distress are you experiencing?” with the question of whether self-report is interpretable and consistent with the clinical course; incorporates observation, collateral information, and longitudinal records as information sources; produces a plan identifying each barrier, the corresponding action, and the responsible party; and verifies access to appointments, records, referrals, and treatment. In conclusion, distress screening may underestimate psychosocial needs and barriers to cancer care in patients with serious mental illness; a consultation-liaison psychiatry framework is needed to complement NCCN screening.

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