Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically significant distress

Abstract

SummaryScreening for distress in cancer patients is recommended by the National Comprehensive Cancer Network, and a Distress Thermometer has previously been developed and empirically-validated for this purpose. The present study sought to determine the rates and predictors of distress in a sample of patients being seen in a multidisciplinary lung cancer clinic. Consecutive patients (N = 333) were recruited from an outpatient multidisciplinary lung cancer clinic to complete the Distress Thermometer, an associated Problem Symptom List, and two questions about interest in receiving help for symptoms. Over half (61.6%) of patients reported distress at a clinically significant level, and 22.5% of patients indicated interest in receiving help with their distress and/or symptoms. Problems in the areas of family relationships, emotional functioning, lack of information about diagnosis/treatment, physical functioning, and cognitive functioning were associated with higher reports of distress. Specific symptoms of depression, anxiety, pain and fatigue were most predictive of distress. Younger age was also associated with higher levels of distress. Distress was not associated with other clinical variables, including stage of illness or medical treatment approach. Similar results were obtained when individuals who had not yet received a definitive diagnosis of lung cancer (n = 134) were excluded from analyses; however, family problems and anxiety were no longer predictive of distress. Screening for distress in a multidisciplinary lung cancer clinic is feasible and a significant number of patients can be expected to meet clinical criteria for distress. Results also highlight younger age and specific physical and psychosocial symptoms as predictive of clinically-significant distress. Identification of the presence and predictors of distress are the first steps toward appropriate referral and treatment of symptoms and problems that contribute to cancer patients' distress.

Desire for psychological support in cancer patients with depression or distress: validation of a simple help question

“…Klank-RieXen et al (2007) found that 40.9% of 115 women with breast cancer expressed an interest in psychosocial support [6]. Graves et al [7] found that among 333 lung cancer patients, only 22.5% wanted help with their problems and, even in those with a high rate of distress, only 30% wanted help. In a crosssectional study of cancer patients in the Netherlands, Tuinman et al [8] screened 277 patients using the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS).…”

Elevated distress among patients undergoing screening for lung cancer

“…In addition to the study questionnaire, levels of distress at the start and conclusion of the lung cancer screening visit were obtained using the NCCN Distress Thermometer (DT), a validated visual analog tool based on an ordinal rating scale from 0 (no distress) to 10 (extreme distress). [15] The DT instrument also includes a section designed to capture those factors influencing the distress score. The categories are subdivided as follows: practical problems (child care, housing, insurance/financial, etc.…”

The lung cancer patient, the pneumologist and palliative care: a developing alliance

“…Besides the well-described five stages of grief (denial, anger, bargaining, depression and acceptance) of KÜBLER-ROSS [58], which are commonly perceived in cancer patients from the very beginning of the disease, the following psychological symptoms and psychiatric disorders were attributed to patients in lung cancer-focused studies or systematic reviews [10,14,[59][60][61][62][63][64][65][66]: depression, anxiety, adjustment disorder, loss of libido, insomnia, suicidal thoughts, delirium, and nicotine and alcohol dependence. Psychological distress was described for all phases along the lung cancer trajectory, even in the favourable cases of survivors [67], but mental health was reported to deteriorate with progression of disease or impairment [68,69].…”

“…Whilst increasing evidence has been published demonstrating successful implementation of palliative care or its elements into standard lung cancer care on the local level [23,62,[176][177][178], a superordinate master plan for better and encompassing delivery of palliative care in lung cancer patients is missing. For that, joint actions by governments and scientific societies are needed.…”