Distress Management

Holland, Jimmie C.; Andersen, Barbara L.; Breitbart, William; Buchmann, Luke; Compas, Bruce E.; Deshields, Teresa L.; Dudley, Moreen M.; Fleishman, Stewart B.; Fulcher, Caryl D.; Greenberg, Donna; Greiner, Carl B.; Handzo, Rev George F.; Hoofring, Laura; Hoover, Charles R.; Jacobsen, Paul B.; Kvale, Elizabeth; Lévy, Michaël; Loscalzo, Matthew; McAllister-Black, McAllister-Black Randi; Mechanic, Karen; Palesh, Oxana; Pazar, Janice P.; Riba, Michelle; Röper, Kristin; Valentine, Alan D.; Wagner, Lynne I.; Zevon, Michael A.; McMillian, Nicole R.; Freedman-Cass, Deborah A.

doi:10.6004/jnccn.2013.0027

Cited by 320 publications

(220 citation statements)

References 131 publications

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“…The DT is a valid measure of distress, with a score of 4 identifying potentially actionable distress as described in NCCN algorithms for psychological/psychiatric treatment. 13 At our center, MDS patients are asked to complete the DT and PL on paper at outpatient visits, and these data are transcribed into the EMR by clinic staff at the point of care. We abstracted data for eligible patients at any visit documented in the medical record during our study period.…”

Section: Methodsmentioning

confidence: 99%

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Troy

Castro

Pupa

et al. 2018

J Natl Compr Canc Netw

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Purpose The National Comprehensive Cancer Network (NCCN) defines distress as a multifactorial, unpleasant emotional experience of a psychological nature that may interfere with patients’ ability to cope with cancer symptoms and treatment. Patients with myelodysplastic syndromes (MDS) are at risk for distress given the largely incurable nature of this hematopoietic malignancy, and its symptom burden, yet associations with clinical outcomes are unknown. Methods We retrospectively reviewed patient-reported distress data from ambulatory adult MDS patients visiting a single, tertiary care medical center from July 2013-September 2015. Demographic, diagnostic, treatment, and comorbidity information were abstracted from records along with the NCCN Distress Thermometer (DT) and Problem List (PL). Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Results We abstracted 376 DT scores (median=1, range=0-10) from 606 visits and 110 patients (median=2 DT/patient, range=1-16). NCCN guidelines suggest DT >=4 should be evaluated for referral to specialty services to address unmet needs. Fifty-four patients (49%) had at least 1 DT >=4 and 20 (18%) had 2 or more DT >=4. Ninety-eight patients (89.1%) reported 1,379 problems during 23,613 person-days of follow-up (median=4 problems/patient/visit, range=1-23). The 5 most frequent were fatigue (181 times; 78 patients), pain (95 times; 46 patients), worry (80 times; 45 patients), sleep (78 times; 41 patients), and tingling hands/feet (68 times; 33 patients). After adjustment for risk stratification at diagnosis, a single point increase on the DT was associated with an increased risk of death (hazard ratio=1.18, 95% confidence interval: 1.01, 1.36). Conclusion MDS patients experience a high burden of distress, and patient-reported distress is associated with clinical outcomes. Distress should be further studied as a prognostic variable and a marker of unmet needs in MDS.

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Section: Methodsmentioning

confidence: 99%

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Troy

Castro

Pupa

et al. 2018

J Natl Compr Canc Netw

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“…This visual analogue scale ranges from ‘no distress’ to ‘extreme distress’. The DT is recommended by the NCCN (Holland et al 2013). A cutoff score of 4/10 is recommended, and has been identified as optimal for research purposes in a sample of cancer survivors (Boyes et al 2013).…”

Section: Methodsmentioning

confidence: 99%

“…In the context of cancer care, it can be understood as a type of distress , defined by the National Comprehensive Cancer Network (NCCN) as an “unpleasant emotional experience” that varies in magnitude and may interfere with coping abilities (Holland et al 2013). Although depression may be referred to as a psychiatric diagnosis, the term is also used to describe subclinical levels of the disorder, as in the present research.…”

Section: Introductionmentioning

confidence: 99%

Oncologists’ perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates

et al. 2015

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BackgroundHealth care providers often inaccurately perceive depression in cancer patients. The principal aim of this study was to examine oncologist-patient agreement on specific depressive symptoms, and to identify potential predictors of accurate detection.Methods201 adult advanced cancer patients (recruited across four French oncology units) and their oncologists (N = 28) reported depressive symptoms with eight core symptoms from the BDI-SF. Various indices of agreement, as well as logistic regression analyses were employed to analyse data.ResultsFor individual symptoms, medians for sensitivity and specificity were 33% and 71%, respectively. Sensitivity was lowest for suicidal ideation, self-dislike, guilt, and sense of failure, while specificity was lowest for negative body image, pessimism, and sadness. Indices independent of base rate indicated poor general agreement (median DOR = 1.80; median ICC = .30). This was especially true for symptoms that are more difficult to recognise such as sense of failure, self-dislike and guilt. Depression was detected with a sensitivity of 52% and a specificity of 69%. Distress was detected with a sensitivity of 64% and a specificity of 65%. Logistic regressions identified compassionate care, quality of relationship, and oncologist self-efficacy as predictors of patient-physician agreement, mainly on the less recognisable symptoms.ConclusionsThe results suggest that oncologists have difficulty accurately detecting depressive symptoms. Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services. This underlines the importance of using validated screening tests. Simple training focused on psychoeducation and relational skills would also allow for better detection of key depressive symptoms that are difficult to perceive.

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“…Because cancer survivors have numerous sources of distress that increase their potential for adjustment reactions, and to reduce the negative stigma of mental health terms, these common reactions are categorized as ‘distress.’ The National Comprehensive Cancer Network (NCCN) Distress Guideline describes distress as extending along a continuum, ranging from common feelings of vulnerability, sadness, and fears of recurrence to disabling depression, anxiety, trauma, panic, and existential crisis. 4 According to psychiatric diagnosis criteria 5 , a generalized anxiety diagnosis requires excessive anxiety or worry that is difficult to control and impairs function, along with at least three of the following symptoms most of the time for the past six months: Restlessness or feeling keyed up or on edgeBeing easily fatiguedDifficulty concentratingIrritabilityMuscle tensionSleep disruptions…”

Section: Symptomsmentioning

confidence: 99%

Anxiety and Depression in Cancer Survivors

Syrjala

2017

Medical Clinics of North America

254

146

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Synopsis Most cancer survivors adjust well to life after cancer but some experience persisting negative mood such as cancer-related fears, post-traumatic stress, anxiety, or depression. Mood fluctuations may not reach criteria for a clinical diagnosis but sub-clinical symptoms can interfere with quality of life. Females, and adolescents and young adults are particularly at risk for mood disturbances. Behavioral interventions such as cognitive behavioral therapy and pharmacological treatments can effectively treat these distressing emotions. Much of the research on managing emotional needs after cancer has been completed with breast cancer survivors and more work is needed with diverse groups of survivors.

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Distress Management

Cited by 320 publications

References 131 publications

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Oncologists’ perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates

Anxiety and Depression in Cancer Survivors

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