Routine screening may help identify patients with cancer at high-risk for self-injury, new study finds

Routine screening with patient-reported outcomes may be used to identify patients with cancer who are at highest risk of self-injury, a new study published today in JAMA Oncology has found.

The study looked at the relationship between patient-reported symptoms and non-fatal self-injury in people newly diagnosed with cancer.

In this population-based matched case-control study of 408,858 patients with a new cancer diagnosis, moderate-to-severe anxiety, depression, and shortness of breath were associated with 61%, 66%, and 65% increase in the odds of non-fatal self-injury in the following 180 days. Each 10-point increment in the total-symptom score was associated with 51% increased odds of subsequent non-fatal self-injury.

What this means, says Sunnybrook Health Sciences Centre surgeon-investigator Dr. Julie Hallet, is that self-reported symptoms scores should be better used to identify patients at highest risk for self-injury so that they can be provided with better supportive care.

“We know that distress following cancer diagnosis is common and that this distress can manifest itself it a variety of ways,” she said. “For this study, we looked at those people with cancer who visited an emergency room for a self-injury — so this is severe distress with a great risk of serious harm.”

Patients with this level of distress may have treatment plans altered or discontinued and have a worse experience within the cancer care system, resulting in poorer outcomes in their cancer care, Dr. Hallet added.

In Ontario, patients with cancer are asked to complete a symptom screening survey each time they visit a cancer centre, for nine symptoms, including nausea, shortness of breath, depression and anxiety. Those with poor scores should be connected with supportive care or other support for symptom management.

Systems for following up on poor scores vary, Dr. Hallet said, and too often management of these reported symptoms are not built into a patient’s treatment plan. She said it is important to determine how best to use the patient-reported data in a clinical setting.

“So we must ask: What support measures are in place and which supports are most effective at reducing self-injury? Is there a better way to flag high-risk patients in our systems so that we can be more proactive in care?”

In addition, she said, work must be done to determine the significant cost of distress and self-injury to the healthcare system and to patient’s cancer outcomes.

“Self-injury events come at a significant cost to both individual patients and to the healthcare system,” Dr. Hallet said. “By providing timely access to proactive support, we can both improve patient outcomes and healthcare costs.”

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