Background: Systematic monitoring of psychosocial distress is a cornerstone of comprehensive cancer care, particularly for oral cancer patients who often experience profound functional and psychosocial challenges related to speech, swallowing, pain, and facial disfigurement. Although routine distress screening and referral to psychosocial support services (PSS) are recommended in North American guidelines, evidence evaluating their real-world implementation in Canadian oncology settings remains limited.
Objectives: This study sought to evaluate the implementation of distress screening referral pathways by examining PSS referral patterns, utilization, and predictors of referral timing among oral cancer patients treated at a Canadian tertiary care centre.
Methods: A retrospective cohort study was conducted using real-world data from patients diagnosed with oral cancer between 2016 and 2023 at the McGill University Health Centre. The cumulative incidence of PSS referral and subsequent service utilization was estimated for the entire study period and on an annual basis. Referred and non-referred patients, as well as psychosocial support service users and non-users, were compared according to sociodemographic, clinical, and lifestyle characteristics using t-tests and chi-square tests. Cox proportional hazards regression models were applied to identify predictors of time to PSS referral.
Results: Of the 348 oral cancer patients included, 35% (n = 122) were referred to PSS, and only 22% (n = 76) had a documented first appointment. Referral rates declined over the study period. Among those referred, nearly two-thirds were referred within two months, and over 90% within 15 months of diagnosis. Notably, patients with advanced-stage disease or higher social deprivation were referred more promptly (p < 0.05), suggesting differential prioritization within the referral process.
Conclusions: Evaluation of psychosocial distress screening revealed that only a subset of patients accessed PSS, highlighting limitations in the reach and effectiveness of existing referral pathways. These findings emphasize the importance of continuous monitoring and the development of system-level interventions to ensure timely and equitable access to psychosocial care. Strengthening referral processes, addressing disparities, and maintaining oversight of screening outcomes are critical to improving supportive care delivery in tertiary oncology centres.