“…The incidence of distress scores of 5 or greater (35%) in this cohort was slightly below the national average of 40%–50% reported in the literature for all cancer types (Mitchell et al, 2012; Vitek et al, 2007); however, it is comparable to that of breast cancer survivors (33%) (Hegel et al, 2008). An inverse relationship was found between distress and QOL, with increased levels of distress resulting in poorer QOL scores, which also correlates with findings from the literature (Chachaj et al, 2010; Foster, Wright, Hill, Hopkinson, & Roffe, 2009; Frumovitz et al, 2005; Hodgkinson, Butow, Fuchs, et al, 2007; Hodgkinson, Butow, Hunt, et al, 2007; Leak, Hu, & King, 2008; Menhert & Koch, 2008; Morrow et al, 2014; Ploos van Amstel et al, 2013; Roland, Rodriguez, Patterson, Trivers, 2013; Taylor et al, 2012). Distress scores of 5 or greater were less likely to be associated with increased referrals and multiple adjuvant treatments.…”