Impact of distress screening and referral on health care utilization and cost among breast cancer patients: a retrospective cohort study∗

Background:Addressing cancer patient distress and unmet needs may reduce health care costs and enhance care utilization. This study examined the impact of a distress screening program CancerSupportSource (TM) (CSS) on health care utilization and costs for breast cancer patients.Methods:In a retrospective cohort study with 2 years' follow-up, breast cancer patients receiving care at a community cancer center in Orlando, FL, between 2016 and 2019 were categorized according to exposure status: screened using CSS and acted by using supportive care services (SA); screened only (SO); and not screened (NS). Patients were matched on breast tumor location and age; screened patients were additionally matched on referral need. Outcomes abstracted from medical records included utilization and cost of emergency department (ED) services, hospital inpatient admissions, and outpatient services; and utilization of integrative medicine department, patient/family counseling, and allied health services.Results:SA patients (n = 36), compared to NS (n = 37), had significantly lower rates of ED visits in negative binomial regression analysis (incidence rate ratio [IRR] 0.43; 95% confidence interval [CI] 0.20-0.93; P = .031). There were significantly higher rates of integrative medicine department visits in SA (IRR 4.20; 95% CI 1.63-10.9; P = .003) and SO (IRR 3.71; 95% CI 1.49-9.24; P = .005) groups compared to NS, and higher rates of patient/family counseling visits in SA (IRR 6.21; 95% CI 1.52-25.3; P = .011). There were no significant differences in 2-year health care costs between groups, controlling for age and race/ethnicity.Conclusions:These findings highlight the potential value of distress screening and referral for health care utilization, shifting use of higher cost services to lower cost nonemergent and preventive care in cancer, and can inform future prospective research on cost outcomes.