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Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management

Swanson, Alysia Jean, BSOM, RN, CCM; Castel, Liana DesHarnais, PhD, MSPH; McKenna, Patricia A., BSN, RN; Shen, Yuming Albert, PhD; Sagar, Bhuvana, MD

doi: 10.1097/NCM.0000000000000336

Purpose of Study: Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals.

Primary Practice Setting: Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017.

Methodology and Sample: A retrospective, matched case–control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1–3 = mild, 4–7 = moderate, and 8–10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services.

Results: More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χ2p < .001).

Implications for Case Management Practice: This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.

Alysia Jean Swanson, BSOM, RN, CCM, leads Clinical Program Development and clinical oversight of Cigna's Oncology Case Management program as Clinical Program Development Manager at Cigna. A certified case manager and Six Sigma Green Belt, she serves as a board member for the Oncology Nurse Society of Chattanooga Tennessee.

Liana DesHarnais Castel, PhD, MSPH, is Editor-in-Chief of Patient Related Outcome Measures (Dove Medical Press, part of Taylor & Francis Group), Adjunct Professor at Campbell University Lundy-Fetterman School of Business, and Business Communication Senior Specialist at Cigna. She holds PhD and MSPH degrees from University of North Carolina–Chapel Hill.

Patricia A. McKenna, BSN, RN, is currently a Project Manager with Cigna Consumer Health Engagement. She received her BSN from Creighton University, College of Nursing, and is a Certified Six Sigma Green Belt.

Yuming Albert Shen, PhD, holds the position of Informatics and Analytics Senior Specialist at Cigna. He holds a PhD in biophysics from University of Virginia, a PhD in statistics from Virginia Tech, and a master's degree in statistics from Columbia University in the City of New York.

Bhuvana Sagar, MD, is Lead Medical Director at Cigna. She completed her MD from Kilpauk Medical College in Chennai, India, residency at St. Luke's-Roosevelt Hospital Center, New York, NY, and fellowship at University of Texas-Medical Branch, Galveston, TX. She is board certified in Internal Medicine and Medical Oncology and actively licensed in Texas.

Address correspondence to Liana DesHarnais Castel, PhD, MSPH, Cigna Health and Life Insurance Company, 900 Cottage Grove Rd, Bloomfield, CT 06152 (

This research has been presented in the form of a poster presentation at the 2018 23rd Annual Conference of the National Comprehensive Cancer Network.

All authors are employed by Cigna. Work performed at and funded by Cigna.

The Cigna name is a registered service mark used herein to refer to operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company and Cigna Behavioral Health, Inc.

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