Impact of a Patient-Access Program with Integrated Distress Screening on Resource Utilization and Psychosocial Distress Levels in Patients with Multiple Myeloma

Background: There is growing awareness of the importance in integrating psychosocial care into routine practice in oncology. A new American College of Surgeons Commission on Cancer accreditation standard requires psychosocial distress screening for patients with cancer as part of an initiative to treat the “whole patient” and ensure quality care. Distress screening at pivotal transition points along the disease continuum can identify problems before a crisis event occurs, allow patients to voice concerns and gain information, and improve the use of healthcare resources. The value of distress screening in patients with multiple myeloma (MM) or by industry patient access programs, however, has received relatively little attention to date. The Cancer Support Community (CSC), in collaboration with Onyx Pharmaceuticals, Inc., an Amgen subsidiary, established an integrated patient assistance program (Onyx 360) to screen and refer patients/caregivers facing advanced MM for psychosocial services. As part of this program, distress screening was performed at baseline and after patients engaged with Onyx 360 resources. Herein, we report results evaluating the impact of distress screening on the utilization of resources offered by Onyx 360 and the effect of these resources on patient distress levels over time.

Methods: The Onyx 360 program was initiated in 2012 and distress screening was introduced in the program in late December 2013. Patients are asked 4 distress screening questions by an Onyx 360 Oncology Nurse Advocate during an initial phone call: 1.) overall level of distress today; 2.) level of concern about practical issues such as home care, transportation, finances, etc.; 3.) level of concern about family, work, or home life; and 4.) level of concern about emotional issues or coping with MM. For each question, patients gauged their level of distress on a scale from 0 to 10 (0-lowest level of distress and 10-highest level of distress). Patients were then offered enrollment in Onyx 360 services, which include reimbursement and clinical support, transportation assistance, and real-time referrals to key resources including the Chronic Disease Fund, the International Myeloma Foundation, the Multiple Myeloma Research Foundation, and the Cancer Support Community. Consenting patients/caregivers were transferred to CSC, whose licensed mental health professionals conducted further distress screening and offered patients/caregivers free supportive counseling, resource referral, group support, and treatment decision counseling. Patients were rescreened with the 4 questions 30 days after the initial call.

Results: Between March 4, 2014 and July 11, 2014, a total of 227 patients in the Onyx 360 program were screened for baseline distress levels. For each screening question, 70%–80% of patients expressed some level of distress (i.e., distress level of ≥1). A total of 172 patients (76%) responded with a distress level of ≥4 for ≥1 of the screening questions; of these patients who were also new to Onyx 360 at the time of the initial call, 86% subsequently enrolled in ≥1 Onyx 360 service including 72% enrolling in transportation services and 27% enrolling in copay assistance. Referral rates to the CSC increased when distress screening was performed compared with when it was not. A total of 145 (64%) patients completed a follow-up call; 74% reported lower levels of distress for ≥1 question since the initial call. Among patients who initially reported a distress level of ≥4 on ≥1 of the screening questions, 79% reported lower levels of distress for ≥1 question since the initial call.

Conclusion: Through a brief distress screening measure, the Onyx 360 program identified patients with psychosocial distress and connected them to a variety of resources and community programs. Patients utilized these resources at a higher rate when distress screening was implemented compared with when it was not. Distress levels decreased after patients engaged with these resources and services; moreover, the decrease in distress levels was greatest in patients who initially had higher levels of distress. These results demonstrate that an integrated patient-centered standard of care improves psychosocial outcomes in patients with advanced MM. Further research is needed to determine whether reduced levels of distress will translate into increased duration of therapy and increase in value to the patient and healthcare system.