At the IPOS 2009 Board Meeting in Vienna, members unanimously endorsed the concept that Distress be named the 6th Vital Sign in Oncology. In routine medial practice Vital Signs are utilized by health professionals in order to assess basic functioning. Vital signs are an essential part of patient's case presentation and generally include: Body Temperature, Pulse (or heart rate), Blood pressure, and Respiratory rate. In 1999, due to the significant impact on patients, Pain was endorsed as the 5th Vital Sign.
Prevalence rates of Distress in cancer patient populations have been well documented in the literature. The impact of distress on cancer patients, families and the community is a primary concern for clinicians, scientists, educators, and IPOS.
Distress as the 6th Vital Sign was first endorsed by the Canadian Strategy for Cancer Control in 2004. The concept of naming Distress as the 6th Vital Sign has gained much support and has been published in Journal of Clinical Oncology, the Journal of Psycho-Oncology, and the Journal of the National Comprehensive Cancer Network to name but a few.
IPOS believes that endorsing Distress, as the 6th Vital Sign will raise awareness of Distress as an essential component of the patient experience and will act as a call to action for care providers and the health care system as a whole.
Barry D. Bultz
IPOS Board Member
June 20, 2009
Naming distress as a vital sign, one of only 6 declared essential aspects in any patient assessment, is a major breakthrough in the move towards a more holistic understanding of the experience of cancer. 'Distress' is a term used to describe the range of unpleasant emotions involved with this disease. It is normal for all patients (and their loved ones) to experience some distress in the setting of cancer. However, like pain (the 5th vital sign) the fact that distress is 'normal' does not mean that nothing can be done to reduce its symptoms.
While psychosocial care clearly improves quality of life in the cancer population, it is suggested that 60% still do not have access to such interventions (Fawzy, 1990). This gap in care is partly due to inadequate funding but is also a result of inadequate methods to identify high risk patients. As a result, much of the psychosocial support that is available is crisis oriented and ad hoc. Clearly earlier identification of those patients with most need enables a more proactive and preventative approach to psycho-social care.
Models of care that incorporate distress screening are being developed world wide in a bid to introduce the detection of clinical levels of distress as a matter of course for all people living with cancer. In Victoria the State Government has made it an aim to document supportive care screening for 50 percent of newly diagnosed cancer patients by 2012 (Victoria’s Cancer Action Plan, 2008-2011).
While valid ways of identifying people with most need for psychosocial intervention have been found in the research setting however, issues around utility and sustainability remain. A number of oncology social workers throughout the country are involved with such research and are working with multi-disciplinary groups to develop models of best practice. Psychosocial issues for people living with cancer are important to all cancer care clinicians and we welcome this acknowledgement of distress as the 6th vital sign from such a prestigious organisation.
Dr. Carrie Lethborg, MSW, PhD
OSWA