Screening for Distress in Breast Cancer

Distress is a common and clinically relevant complication of breast cancer which can occur at any time. Several organizations have recommended systematic screening for distress but, because there is still a debate about its effectiveness, uptake has been slow. Screening research can be divided into studies of diagnostic validity that test the accuracy of particular tools and studies involving screening implementation that test the clinical success of screening. Despite many cross-sectional validation studies, few have specifically studied breast cancer patients. Only one short tool, the distress thermometer (DT), and a longer tool, the hospital anxiety and depression scale (HADS) have been evaluated in both types of study in more than one centre. Multidomain tools, for example the Edmonton symptom assessment system (ESAS) and the Emotion Thermometer (ET), are promising, and are currently under evaluation. Current evidence suggests that for any mental disorder (including adjustment disorder) the DT has sensitivity of 84 % and specificity of 63 % and the HADS has sensitivity of 65 % and specificity of 77 %. Evidence to date suggests that the DT and HADS are moderately accurate when helping identify distress, performing best in screening (initial assessment), but only slightly increase referrals for psychosocial care. However, their effect can be magnified by combining screening with mandatory follow-up.