Screening for distress in cancer patients

Abstract

on behalf of the Italian Society of Psycho-Oncology Distress Thermometer Study Group BACKGROUND: Routine screening for distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on quality of life. The objective of the current study was to contribute to the Italian validation of the Distress Thermometer (DT) to determine whether the single item DT compared favorably with referent criterion measures. METHODS: In total, 1108 outpatients with cancer were recruited from 38 representative oncology centers in Italy. Each participant completed the DT and a list of 34 possible cancer-related problems (the Problem List), the Hospital Anxiety and Depression Scale (HADS), the 18-item Brief Symptom Inventory (BSI-18), and a short visual analog scale to determine the understandability of the tools. RESULTS: Receiver operating characteristic analysis revealed that DT cutoff scores !4 and !5 had optimal sensitivity and specificity relative to both HADS and BSI-18 cutoff scores for general caseness and more severe psychological distress, respectively. Patients with DT scores !4 (cases) were more likely to be women; to have had psychological problems in the past; to report more stressful events in the last year; and to currently have more family, emotional, and physical problems related to cancer or cancer treatment. Patients indicated that the DT was easier to fill out and to understand than the HADS, but not the BSI-18. CONCLUSIONS: The DT was identified as a simple and effective screening instrument for detecting distress in Italian cancer patients as a first step toward more properly referring those in need to psychosocial intervention.

Depression and anxiety symptoms following cancer diagnosis: a cross-sectional study

“…They were significantly higher and more prevalent in women confirming gender differences in cancer (Grassi et al, 2013;Keller & Henrich, 1999).…”

“…It overlaps anxiety and depression, including a continuum from common normal adjustment to depression and anxiety disorders (NCCN, 2012). Psychological distress prevalence rates in patients with cancer range from 22 to 58% (Grassi et al, 2013;Vodermaier, Linden, MacKenzie, Greig, & Marshall, 2011) with increased levels associated with the more advanced stages, poorer prognosis, and invasive treatment (Vodermaier et al, 2011).…”

Which items on the distress thermometer problem list are the most distressing?

“…The number of PL items related to distress in studies using chi-square analysis has been reported as 22/33 [10], 23/35 [11] and 32/33 [12]. Studies using correlational approaches have also reported significant relationships between distress and most PL items [13,14].…”

The effects of psychosocial interventions in early breast cancer survivors: a systematic review and meta-analysis

“…Although reports in literature demonstrate high levels of QoL in long-term cancer survivors there are studies that indicate the presence of persistent levels of emotional distress even after 2-10 years of diagnosis with a marked prevalence of anxious and depressive symptoms that are not always detected (6). Psychosocial interventions based on emotional distress early screening with periodic follow-up and on short crisis interventions for anxiety and depression could be useful as interventions directed at specific behavioral changes improve targeted outcomes.…”

“…The in-creased number of breast cancer patients who survive, live with physical, psychological, social and sexual issues a long time after diagnosis and active treatment. International studies carried out in recent years demonstrate that the 30-35% of people with cancer shows symptoms of distress and psychological suffering (4,5) and that long cancer survivors have persistent levels of emotional distress even 2-10 years after diagnosis, with a marked prevalence of anxiety and depressive symptoms (6). Overall in the context of a positive quality of life, a third of women continue to report psychological distress, sexual problems, cognitive difficulties, changes in role and social functioning (7)(8)(9).…”