Tailoring Distress Screening in Oncology Populations: Timing distress screening in surgically resectable esophageal cancer

Abstract

Objectives

Distress screening has now become part of the culture of cancer care, with clinical practice guidelines set forth by the National Comprehensive Cancer Network (NCCN) and requirements by the Commission on Cancer (CoC). Because interdisciplinary teams are specialists in treating certain disease sites, it is important to develop distress screening guidelines that best serve that patient population and their treatment.

Methods

A retrospective review of patients with surgically resectable esophageal cancer who were treated at a single institution was performed. Patients voluntarily undergoing the prehabilitation program (n = 11) received a structured protocol intervention in several clinical domains, including psychosocial distress screening.

Results

Despite having a protocol, variations in the number of times patients were screened for distress (range, 1-9 times; mean = 4.73) suggests that the protocol was not accomplished. Elapsed time between first and final distress screens ranged from 0 to 68 days (mean = 40.27), and time from final distress screen to surgery ranged from 50 to 122 days, with a mean of 76.45 days.

Significance of Results

The pilot prehabilitation program demonstrated difficulties with the distress screening protocol. Subsequently, a more comprehensive distress screening program is recommended in this highly vulnerable patient population by aligning the NCCN distress management screening guidelines with the clinical pathway for treating surgically resectable esophageal cancer. With the difficult prognosis and treatment known for patients with esophageal cancer, tailored distress screening protocols should be implemented throughout the duration of treatment.

Additional information

Notes on contributors

Laura Melton

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Michelle Bunch

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Lisa J. Wingrove

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Megan D. Marsh

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Ashley E. Glode

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Stephen Leong

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

S. Lindsey Davis

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Tracey E. Schefter

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Supriya K. Jain

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Lindel C.K. Dewberry

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Karyn Goodman

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

W. Thomas Purcell

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.

Martin D. Mccarter

Laura Melton, PhD, is the former director of Supportive Care Services at University of Colorado Hospital, Aurora, Colo. Stephen Leong, MD, is the executive director, Scientific Affairs at Merck, North Wales, Pa. He was formerly at University of Colorado Hospital when the research was conducted. S. Lindsey Davis, MD, is a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. W. Thomas Purcell, MD, is the associate director for Clinical Services at the University of Colorado Cancer Center; System Director- Oncology Service Line; UCHealth Executive Medical Director of Cancer Services; University of Colorado Hospital Chief Medical Officer- UCHealth Highlands Ranch Hospital; and a medical oncologist and associate professor in the Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colo. Michelle Bunch, MA, is a licensed clinical social worker at Porter Adventist Hospital, Denver, Colo. She was working at University of Colorado Hospital when the project was conducted. Lisa J. Wingrove, RD, CSO, is a registered dietitian at Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, Colo. She was working at University of Colorado Hospital when the research was conducted. Megan D. Marsh, PA-C, MPAS, is a senior instructor and physician assistant in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Martin D. McCarter, MD, is the surgical director for the Esophageal and Gastric Multidisciplinary Clinic, vice chair for Strategy and Program Development, surgical oncologist, and professor in the Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, Colo. Ashley E. Glode, PharmD, is an associate professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo. Tracey E. Schefter, MD, is a radiation oncologist and professor in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Supriya K. Jain, MD, is a former resident in the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colo. Karyn Goodman, MD, MS, is the associate director for Clinical Research at the Tisch Cancer Institute and professor and vice chair for Research and Quality and radiation oncologist in the Department of Radiation Oncology at Mount Sinai Health System, New York, N.Y. She was working at University of Colorado Hospital when the research was conducted. Lindel C.K. Dewberry, MD, is a former fellow in the Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.