Prevalence of distress in cancer patients undergoing chemotherapy

Aim: Feeling distressed is often a normal reaction to the diagnosis of cancer and cancer treatment. However, if excessive, distress may lead to more disabling conditions such as depression and anxiety. The aims of the study were to determine the prevalence and level of distress in patients with cancer who were undergoing chemotherapy and to examine the associated factors related to psychological distress in these patients. Methods: Adult patients with confirmed cancer who were undergoing out‐patient chemotherapy at the Clinical Oncology Unit, Universiti Malaya Medical Centre were invited to participate in the study. They were assessed on their sociodemographic profiles, clinical history, distress level as measured using the ‘Distress Thermometer’, and problems checklist on practical, family, emotional and physical symptoms. The Hospital Anxiety Depression Scale (HADS) was used by patients to report anxiety and depression. Results: One hundred and sixty‐eight patients with mean age of 50 years participated in the study. The prevalence of psychological distress determined by the ‘Distress Thermometer’ was 51%. HADS found the prevalence of depression/anxiety to be 32%. There was no significant association between distress and the primary site of cancer, the phase of chemotherapy and the sociodemographic profiles except for age (r = ?0.21, P = 0.007). Distress was significantly associated with practical, family and emotional problems. Some of the physical problems such as appearance, breathing, changes in urination, constipation, eating, fatigue, getting around, memory/concentration, nausea, pain and sleep were also significantly associated with distress. Conclusion: Cancer patients undergoing chemotherapy experienced high level of distress. This finding should alert oncologists that some patients exhibiting these signs of distress may need referral to the mental health team.     

Distress persists in long-term brain tumor survivors with glioblastoma multiforme

Introduction  Glioblastoma multiforme (GBM) is the most common and aggressive type of primary brain tumor. The prognosis for GBM patients is extremely poor with an estimated median survival of 12 months. Despite this statistic, a number of GBM patients are living longer than in the past as new detection and treatment approaches are used. However, little is known about the psychological correlates of this disease. To address this issue we investigated distress and its sources in long-term survivors (LTS) of this disease. Materials and methods  Participants were asked to complete the National Comprehensive Cancer Network’s (NCCN) Distress Thermometer, a single-item rapid screening tool for distress. Participants were also asked to designate sources of distress from a 34-item list developed by the NCCN. Distress scores and sources of distress for long-term GBM survivors (>18 months) were compared to patients diagnosed within the last 18 months (<18 months). Results  Eight-three brain tumor patients participated in this study. Fifty-nine percent of LTS met the ≥ 4 cut-off score for distress (M = 4.61, SD 3.12) as compared to 49% of patients diagnosed less than 18 months (M = 3.93, SD = 2.21; x² = 0.406, NS), LTS reported fewer items of concern while more LTS reported being distressed. Conclusions  This study indicates that LTS of GBM report experiencing distress at similar levels to other brain tumor patients. Level of distress for LTS is directly related to the total number of concerns in both emotional and physical domains. Implications for cancer survivors  Regardless of LTS status, distress continues to be a part of the disease trajectory for many GBM patients. As such, attention to distress in these survivors of a major life threatening disease is warranted in follow up surveillance visits.     

Distress in women with gynecologic cancer

Objective: The NCCN Distress Thermometer (DT) was administered to 143 women undergoing chemotherapy for gynecologic cancer over a two‐year period. This report describes the frequency and character of psychological distress in this population and examines the effect of disease, treatment, and demographic variables on levels of distress. Method: The DT is a self‐administered scale for patients to rate their level of distress from 0 to 10, where 0 represents no distress and 10 represents extreme distress. Further, patients are asked to choose from among 34 items that constitute sources of distress within the last week. All women who were undergoing their first chemotherapy treatment at the outpatient clinic at the University of Oklahoma Cancer Institute for either primary disease or recurrent disease were asked by the clinical nurses to complete the assessment prior to that first infusion. Results: Over half (57%) of women reported a score of 4 or greater on the DT and were then assessed by the oncology psychologist. Women who were younger than age 60 and single were more likely to be distressed. There were no associations between the type of cancer, stage of cancer, or insurance status. Conclusions: A significant percentage (57%) of these women experienced distress at levels that indicate further evaluation is indicated. This study suggests that early screening and evaluation are essential in this group of cancer patients.Copyright © 2009 John Wiley & Sons, Ltd.     

Distress,anxiety, depression,and emotional well‐being in African‐American men with prostate cancer

Objective: African‐American men have an incidence rate of prostate cancer 60% higher than Caucasian men. Over one‐quarter of men with prostate cancer experience significant distress, yet psychosocial research has rarely focused on African‐American men. This study presents novel data on emotional well‐being, distress, anxiety, and depression in African‐American men with prostate cancer. Methods: This archival research combined two databases (N=385 and N=367) comprised of 55 African‐American men with prostate cancer. Quality of life was assessed with the Functional Assessment of Cancer Therapy, distress was measured with the Distress Thermometer, and anxiety and depression were measured with the Hospital Anxiety and Depression Scale. African‐American and Caucasian men were matched on age, education, and stage of disease, and compared on emotional well‐being, distress, anxiety, and depression. Results: The mean age of the 55 African‐American was 63 years old. In non‐matched comparison, African‐American men had elevated levels of distress, anxiety, and depression similar to Caucasian men. African‐American men reported high levels of clinically significant distress (>31%) and anxiety (>23%). However, after matching the African‐American and Caucasian men, African‐American men reported higher mean scores on emotional well‐being (p<0.05) and a lower percentage of African‐American men displayed clinically significant depressive symptoms (p<0.05) compared with Caucasian men. Conclusions: After matching the sample, African‐American men seem to display a sense of resilience, demonstrating greater emotional well‐being and a lower incidence of clinically significant depressive symptoms, compared with Caucasian men. This is consistent with cross‐cultural research outside of prostate cancer. Continued research is needed to further elucidate the concept of resiliency in African‐American men with prostate cancer. Copyright © 2010 John Wiley & Sons, Ltd.     

The 'Distress Barometer': validation of method of combining the Distress Thermometer with a rated complaint scale

Objective: Screening instruments may enhance the clinician's ability to detect elevated levels of distress in cancer patients, but these are often neither suitable nor effective for the routine of daily care for cancer patients. The newly developed Distress Barometer (DB) was intended to provide medical doctors with a convenient tool to interpret ‘at single glance’ the nature and the intensity of distress in ambulatory cancer patients. The DB, i.e. a combination of the Distress Thermometer (DT) and a new tool, the Colored Complaint Scale was developed to improve the specificity of distress screening without decreasing the sensitivity of the Distress Thermometer. Methods: Distress was screened in a sample of 538 out‐patients, using the Hospital Anxiety and Depression Scale (HADS) and the new Distress Barometer (DB). Results: The results confirm the validity of the Dutch version of the DT against the HADS as standard measure. In addition, it was found that the overall accuracy of the new DB was higher, with a sensitivity of 0.79 and a specificity of 0.81. Conclusion: These results indicate that the Distress Barometer, which is convenient for both patients and doctors, can be used as an acceptable, brief and sufficiently accurate method for detecting distress in cancer patients. Copyright © 2008 John Wiley & Sons, Ltd.     

Validation of an item bank for detecting and assessing psychological distress in cancer patients

Objective: To validate an item bank for assessing and detecting psychological distress in cancer patients by (1) identifying whether additional items are required in the full item bank; (2) identifying any item bias in the existing item bank; (3) linking levels of distress against thresholds derived from gold‐standard psychiatric interviews (PSE/SCAN/SCID). Method: A Rasch analysis was conducted on a heterogeneous sample of cancer patients (n=4919) who had completed a combination of eight psychological distress screening instruments. A subset of patients had completed a psychiatric interview along with the HADS (n=381) or PHQ‐9 (n=440). Item thresholds were plotted along the latent trait. Furthermore, items were assessed for differential item functioning (DIF) by age and gender. Finally, optimum thresholds were derived for the HADS and PHQ‐9 and plotted along the latent trait distribution for the entire item bank. Result: Item thresholds exceeded the range of person measures, although a gap was still present along the latent trait. No DIF was observed for either age or gender. Putative cut‐offs were derived for the item bank detecting moderate to severe levels of psychological distress. Conclusion: The item bank covers the majority of levels of emotional distress reported by cancer patients. Additionally, initial thresholds have been derived on the item bank, which correspond to a formal psychiatric assessment. Further work is required to ascertain the stability of the item bank over time and by diagnosis and stage of disease, as well as to determine additional thresholds for levels of distress. Copyright © 2008 John Wiley & Sons, Ltd.     

An examination of distress, sleep, and fatigue in metastatic breast cancer patients

Objective: Few studies have used rapid screening instruments to document the prevalence of distress among metastatic breast cancer patients. This study used the one‐item Distress Thermometer (DT) to assess distress in this population. Anxiety and depressive symptoms, sleep problems, fatigue, and mental health service use were assessed for patients who met the cutoff on the DT for probable distress (score ?4). Methods: A total of 173 metastatic breast cancer patients rated their distress on the DT. Respondents who met study eligibility criteria (n = 90), including a score ?4 on the DT, completed a telephone survey 1 week later that assessed anxiety, depressive symptoms, sleep problems, and fatigue. Associations of study outcomes with demographic and medical characteristics were computed. Results: Sixty percent of the 173 patients met the cutoff for probable distress on the DT. Meeting this cutoff was not associated with age, ethnicity, time since diagnosis, or medical treatments. The majority (61%) of respondents who were classified as distressed on the DT reported clinically significant anxiety or depressive symptoms 1 week later. On average, these patients also showed significant fatigue and sleep disturbance, with 70% reporting decrements in sleep quality. Only 29% of patients with significant anxiety or depressive symptoms accessed mental health services. Conclusions: Results point to a high prevalence of distress, sleep problems, and fatigue across demographic and medical subgroups of metastatic breast cancer patients. A rapid one‐item screening tool may be used to identify patients with a potential need for psychosocial assessment and intervention. Copyright © 2010 John Wiley & Sons, Ltd.     

Mindfulness‐based Cancer Stress Management: impact of a mindfulness‐based programme on psychological distress and quality of life

Within the area of cancer care, mindfulness‐based therapeutic interventions have been found to be efficacious in reducing psychological distress related to a cancer diagnosis; however, the impact of mindfulness‐based interventions on quality of life is unclear. This study explores the impact of a Mindfulness‐Based Cancer Stress Management programme on psychological distress and quality of life. Research methodology included a single‐group quasi‐experimental study of 26 participants experiencing distress related to a cancer diagnosis, including carers, who completed an MBCSM programme and all assessments. Participants completed the Functional Assessment of Cancer Therapy – General version 4 (FACT‐G) and its associated spirituality index (FACIT‐Sp‐Ex), Hospital Anxiety and Depression Scale (HADS), Freiburg Mindfulness Inventory (FMI), and the Distress Thermometer at baseline, post‐intervention, and three months after programme completion. Significant improvements were observed on all measures (ranges: P ≤ 0.001 to 0.008, r = ?0.53 to ?0.79) following the intervention, which were maintained at 3‐month follow‐up. Mindfulness was significantly correlated with all main outcome measures at post‐intervention (range: r = ?0.41 to 0.67) and 3‐month follow‐up (range: r = ?0.49 to 0.73), providing evidence for the internal validity of the study. Our findings indicate that the MBCSM programme is effective in reducing psychological distress and improving quality of life, including spiritual well‐being.     

Distress screening in oncology—evaluation of the Questionnaire on Distress in Cancer Patients—short form (QSC‐R10) in a German sample

Objective: The aim was to examine the psychometric properties of the Questionnaire on Stress in Cancer Patients (QSC‐R10), a 10‐item screening instrument for self‐assessment of psychosocial distress in cancer patients. Methods: A total of 1850 cancer patients were assessed with the QSC‐R10. Patients were recruited from different inpatient and outpatient settings in Germany between 2007 and 2009. Results: Mean age of the sample was 62.9 (SD=12.4) with breast cancer as the most frequent diagnosis (35.2%). The analysis indicated high reliability (Cronbach's α=0.85) and test–retest reliability (ICC=0.89). Validation scales included the Hospital Anxiety and Depression Scale (HADS), Distress–Thermometer (DT), European Organization for Research and Treatment of Cancer QLQ‐C30 (EORTC QLQ‐C30) and Karnofsky Performance Status (KPS). Convergent validity was highest for the HADS total score (r=0.74) and the lowest correlation for KPS (r=?0.36). The QSC‐R10 significantly distinguished subgroups by their clinical characteristics (metastases, illness duration, previous psychiatric treatment and psycho‐oncological support; p<0.001). A cutoff score of >14 demonstrated good sensitivity (81.0%) and specificity (73.2%) and is suitable to determine the need for psychosocial support. Conclusion: The QSC‐R10 is a valid and reliable questionnaire to detect distress in cancer patients with high acceptance among professionals and patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Cancer patients' reluctance to disclose their emotional distress to their physicians: a study of Japanese patients with lung cancer

Purpose: To explore cancer patients' concerns about emotional disclosure (ED) to their physicians, and to investigate the factors associated with them. Subjects and Methods: Randomly selected ambulatory patients with lung cancer participated in this study. An 18‐item questionnaire to assess patients' beliefs regarding ED to their physicians was developed for this study. Factor analysis was used to extract the underlying factors of this scale. Patients were asked to answer this questionnaire along with other self‐administered questionnaires. Results: Complete data were available from 104 patients. Four factors were extracted by factor analysis: ‘Hesitation to disturb the physicians by ED’, ‘No perceived need for ED’, ‘Negative attitude towards ED’, and ‘Fear of a negative impact of ED’. All factors reached standards of internal consistency. The prevalence of the above concerns, in that order, among the patients was 68, 67, 46, and 20%. Patients with high distress levels were significantly more likely to endorse ‘Negative impact’ (p=0.02). Older patients were more likely to report ‘Negative attitude’ (p=0.06), whereas male patients were more likely than females to report ‘Hesitation’ (p=0.05). Conclusion: Knowledge of such patient‐related barriers should better prepare physicians to build good communication channels with their cancer patients. Copyright © 2007 John Wiley & Sons, Ltd.     

Distress among African American and White adults with cancer in Louisiana

Abstract

Purpose/Objectives: Screening for distress is a key priority in cancer care, and African American patients may experience increased distress compared to White patients. However, this question has not yet been addressed in Louisiana. The purpose of the present study was to examine the relationship between African American race and distress at a cancer center in Louisiana.

Design/Methods: This was a retrospective study of 1,544 patients who were treated at an academic cancer center in 2015. Extracted data included patient self-reports of distress using the single-item Distress Thermometer (DT) and demographic and clinical characteristics. Hypotheses were tested using logistic regression.

Findings: Distress was present in 19.7% of the sample. In univariate analyses, African American patients were more likely than White patients to experience distress (OR?=?1.38, p?=?.013). However, race was no longer associated with distress in a multivariate analysis that adjusted for the covariates of age, gender, cancer site, presence of metastases, and number of distress screenings (OR?=?1.07, p?=?.670). Distress was more common in patients who were younger (OR?=?2.26, p?<?.001), diagnosed with lung/bronchus cancer (OR?=?5.28, p?<?.001), or screened more often (OR?=?5.20, p?<?.001). Distress was less common among patients with female breast cancer (OR?=?0.39, p?=?.015).

Conclusions/Implications: This study suggests that African American individuals with cancer in Louisiana are at increased risk for distress, but that this can be attributed to African American patients being younger, more likely to have lung cancer, and screened more frequently. Implications include careful consideration of patient race, age, and cancer site during distress management in cancer care.     

The psychometric properties of the Icelandic version of the distress thermometer and problem list

Objective: While a significant number of cancer patients experience distress only a minority are offered appropriate psychosocial interventions. Untreated distress can interfere with compliance to treatment and quality of life. The purpose of this study was to evaluate the psychometric properties and feasibility of the Icelandic translation of the Distress Thermometer (DT) and Problem List, a tool developed to screen for distress in cancer patients. Methods: Participants were 149 cancer patients receiving treatment at outpatient oncology clinics at Landspítali‐The National University Hospital of Iceland, mean±SD age 59.06 years±12.92. Participants answered the DT, HADS and GHQ‐30, demographic questions and questions regarding the DT. Results: Scores on the DT ranged from 0 to 10 with a mean±SD score of 3.09±2.40, 7.30 ± 4.86 on HADS and 5.28 ± 5.60 on GHQ‐30. Significant correlations were between the DT and all categories on the Problem List as well as between the DT and HADS (r = 0.45), and between DT and GHQ‐30 (r = 0.57). ROC‐analysis supported that a cut‐off point of 3 gives the best sensitivity and specificity for the DT predicting depression or anxiety according to the HADS and GHQ. Sixty‐nine (48.3%) patients scored ?2 on DT and 74 (51.7%) scored ≥3. Conclusion: The Icelandic version of the DT is a valid instrument to screen for distress in clinical practice. The study adds to a growing literature suggesting that this brief instrument may aid in identifying cancer patients suffering from distress and consequently providing appropriate treatment. Copyright © 2011 John Wiley & Sons, Ltd.     

Breast cancer patients receiving postoperative radiotherapy: Distress, depressive symptoms and unmet needs of psychosocial support

Background and purpose

The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and distress, and unmet needs for psychosocial support were assessed among breast cancer patients receiving postoperative radiotherapy.

Material and methods

Out of 389 consecutive patients, 276 responded and comprised the final study group. Depressive symptoms were assessed with the Beck Depression Inventory. Distress was measured with the Distress Thermometer. Hospital records of the patients were examined for additional information.

Results

Nearly one third of patients (32.1%) displayed depressive symptoms, and more than a quarter of patients (28.4%) experienced distress. Younger age (p = 0.001) and negative hormone receptor status (p = 0.008) were independent factors associated with distress. One quarter of the patients expressed an unmet need for psychosocial support, which was independently associated with depressive symptoms and/or distress (p = 0.001) and younger age (p = 0.006).

Conclusions

During radiotherapy for breast cancer, the staff should have awareness of the higher risk of depression and distress in their patients and should consider screening tools to recognise distress and depressive symptoms. Special attention should be paid to younger patients.     

The mediating effects of social support and self-efficacy on the relationship between social distress and emotional distress in head and neck cancer outpatients with facial disfigurement

Objective: Although social support has been recognized as an important factor in the quality of life of head and neck cancer patients, there has been little investigation of the buffering effect of social support on these patients' social distress or of the coping skill of self‐efficacy. The aim of this study was to examine how social support and self‐efficacy mediate the relationship between social distress and emotional distress in head and neck cancer patients. Methods: Two hundred twenty‐five head and neck cancer patients completed our questionnaire (effective response rate, 92.2%). Of these, 129 (57.3%) had facial disfigurement. These participants responded to questions about perception of social distress, social support, self‐efficacy, and emotional distress (depression and anxiety). We used structural equation modeling for statistical analysis. Results: The fit indices of this model were excellent ( χ ² (7) = 9.147, p = 0.242, goodness of fit index (GFI) = 0.981, adjusted goodness of fit index (AGFI) = 0.922, comparative fit index (CFI) = 0.993, root mean square error of approximation (RMSEA) = 0.049). Self‐efficacy strongly buffered the negative influence of social distress on emotional distress. Social support from family members did not have a direct or indirect influence on emotional distress. Social support from friends was related to lower social distress and higher emotional distress. Conclusions: Our findings suggest that self‐efficacy might confound the relationship between social support and emotional distress, and that different sources of social support might play different roles in the mediation of social distress on emotional distress. Copyright © 2010 John Wiley & Sons, Ltd.     

Feasibility and usefulness of the ‘Distress Screening Program in Ambulatory Care’ in clinical oncology practice

Objective: Although the implementation of routine screening for distress is desirable, doing so is difficult in today's busy clinical oncology practice. We developed the ‘Distress Screening Program in Ambulatory Care’ (DISPAC program) as a practical means of screening for and facilitating the treatment of major depression and adjustment disorders in cancer patients. This study assessed the feasibility and usefulness of the DISPAC program in actual clinical situations. Methods: As part of the DISPAC program, nurses administered a psychological screening measure, the Distress and Impact Thermometer (DIT), to consecutive cancer patients visiting an outpatient clinic in the waiting room. The attending physician then recommended psycho‐oncology service referral to all positively screened patients. We compared the proportion of patients referred to a psycho‐oncology service during the DISPAC period with the usual care period. Results: Of the targeted 491 patients treated during the DISPAC period, 91.9% (451/491) completed the DIT; the results were positive in 37.0% (167/451), recommendations for referrals were given to 93.4% (156/167), and 25.0% (39/156) accepted the referral. Ultimately 5.3% (26/491) of the targeted patients were treated by psycho‐oncology service as having major depression or adjustment disorders, a significantly higher proportion than during the usual care period (0.3%; p<0.001). The nurses required 132±58 s per person to administer the DIT. Conclusions: The DISPAC program is useful for facilitating the care of cancer patients with psychological distress. Nevertheless, the acceptance of referrals by patients and the reduction of the burden placed on nurses are areas requiring improvement. Copyright © 2009 John Wiley & Sons, Ltd.     

Accuracy of the Danish version of the 'distress thermometer'

Objective: Short screening instruments have been suggested to improve the detection of psychological symptoms. We examined the accuracy of the Danish version of the ‘Distress Thermometer’. Methods: Between October 2008 and October 2009, 426 women with newly diagnosed primary breast cancer who were operated at the Breast Surgery Clinic of the Rigshospitalet, Copenhagen, were eligible for this study. Of these, 357 participated (84%) and 333 completed a questionnaire. The distress thermometer was evaluated against the ‘hospital anxiety and depression scale’ (HADS). We also examined the women's wish for referral for psychological support. Results: A cut‐off score of 6 vs 7 (low:?6, high:?7) on the distress thermometer was optimal for confirming distress, with a sensitivity of 42%, a specificity of 93%, a positive predictive value (PPV) of 78% and a negative predictive value (NPV) of 73%. A cut‐off score of 2 vs 3 was optimal for screening, with a sensitivity of 99%, a specificity of 36%, a PPV of 47% and a NPV of 99%. Of those who were distressed using the cut‐off score of 2 vs 3 on the distress thermometer, 17% (n = 41) wished to be referred for psychological support and 57% (n = 140) potentially wanted a later referral. Conclusion: The distress thermometer performed satisfactorily relative to the HADS in detecting distress in our study. A screening procedure in which application of the distress thermometer is a first step could be useful for identifying persons in need of support. Copyright © 2011 John Wiley & Sons, Ltd.     

The validity of the Distress Thermometer in female partners of men with prostate cancer

Female partners of prostate cancer (PCa) survivors experience heightened psychological distress that may be greater than that expressed by PCa patients. However, optimal approaches to detect distressed, or at risk of distress, partners are unclear. This study applied receiver operating characteristics analysis to evaluate diagnostic accuracy, sensitivity and specificity of the Distress Thermometer (DT) compared to widely used measures of general (Hospital Anxiety and Depression Scale) and cancer‐specific (Impact of Events Scale‐Revised) distress. Participants were partners of men with localised PCa (recruited around diagnosis) about to undergo or had received surgical treatment (N = 189), and partners of men diagnosed with PCa who were 2–4 years post‐treatment (N = 460). In both studies, diagnostic utility of the DT overall was not optimal. Although area under the curve scores were acceptable (ranges: 0.71–0.92 and 0.83–0.94 for general and cancer‐specific distress, respectively), sensitivity, specificity and optimal DT cut‐offs for partner distress varied for general (range: ≥2 to ≥5) and cancer‐specific (range: ≥3 to ≥5) distress both across time and between cohorts. Thus, it is difficult to draw firm conclusions about the diagnostic capabilities of the DT for partners or recommend its use in this population. More comprehensive screening measures may be needed to detect partners needing psychological intervention.     

Screening for distress can predict loss of follow-up and treatment in cancer patients: results of development and validation of the Distress Inventory for Cancer Version 2

Introduction: The evidence suggests that in most instances distress from cancer goes unrecognised. There has been substantial work in screening for distress leading to development in practice guidelines recommending screening for distress. There is a need to identify distress early in the continuum, where suitable and timely interventions will benefit the patient. The Distress Inventory for Cancer (DIC) was designed for this. Methods: The present study reports the improved psychometric properties of the second version of the DIC (DIC 2). A standardisation sample of 520 patients was administered the 73‐item draft questionnaire as well as the Functional Assessment of Cancer Therapy—General (FACT‐G). Additional 240 patients were administered Hospital Anxiety and Depression Scale (HADS) besides the final DIC 2 and FACT‐G. Internal consistency was measured with the Cronbach's alpha. Chi‐square, odds ratio, and binary logistic regression were used to compare the results of three tools and to establish validity. Results: A principal factor analysis of the 73‐item draft questionnaire with varimax rotation in a six‐factor structure resulted in 33 items. Activity of daily living emerged as a single item domain. The FACT‐G scores negatively correlated with DIC 2 scores, while emotional distress of DIC 2 overlapped with anxiety in HADS. DIC 2 significantly predicted patient non‐compliance to treatment and follow‐up. Conclusion: The results show a suitable internal consistency, construct, and convergent/divergent validity of the global distress measure (DIC 2). The DIC 2 also demonstrates a predictive function for future negative clinical behaviour, the knowledge of which may facilitate better intervention triage. Copyright © 2008 John Wiley & Sons, Ltd.     

Screening for distress in cancer patients

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. Cancer 2013. © 2013 American Cancer Society.