Establishing the sensitivity and specificity of the gynaecological cancer distress screen.

OBJECTIVE: Nuanced distress screening tools can help cancer care services manage specific cancer groups' concerns more efficiently. This study examines the sensitivity and specificity of a tool specifically for women with gynaecological cancers (called the Gynaecological Cancer Distress Screen or DT-Gyn). METHODS: This paper presents cross-sectional data from individuals recently treated for gynaecological cancer recruited through Australian cancer care services, partner organisations, and support/advocacy services. Receiver operating characteristics analyses were used to evaluate the diagnostic accuracy of the DT-Gyn against criterion measures for anxiety (GAD-7), depression (patient health questionnaire), and distress (IES-R and K10). RESULTS: Overall, 373 individuals aged 19-91 provided complete data for the study. Using the recognised distress thermometer (DT) cut-off of 4, 47% of participants were classified as distressed, while a cut-off of 5 suggested that 40% had clinically relevant distress. The DT-Gyn showed good discriminant ability across all measures (IES-R: area under the curve (AUC) = 0.86, 95% CI = 0.82-0.90; GAD-7: AUC = 0.89, 95% CI = 0.85-0.93; K10: AUC = 0.88, 95% CI = 0.85-0.92; PHQ-9: AUC = 0.85, 95% CI = 0.81-0.89) and the Youden Index suggested an optimum DT cut-point of 5. CONCLUSIONS: This study established the psychometric properties of the DT-Gyn, a tool designed to identify and manage the common sources of distress in women with gynaecological cancers. We suggest a DT cut point ≥5 is optimal in detecting 'clinically relevant' distress, anxiety, and depression in this population.

Adherence to adjuvant endocrine therapy for breast cancer: a qualitative exploration of attribution of symptoms among post-menopausal women.

PURPOSE: Oral adjuvant endocrine therapy (AET) is an effective treatment for hormone receptor positive breast cancer to decrease recurrence and mortality, but adherence is poor. This study explored post-menopausal women's experiences with AET, with a particular focus on adherence to AET as well as distress and symptoms experienced prior to and during AET treatment. METHODS: Participants were recruited from a hospital registry, stratified by adherence to/discontinuation of AET. Telephone interviews followed a semi-structured interview guide and were recorded and transcribed verbatim. Transcripts were systematically coded using team-based coding, with analysis of themes using a grounded theory approach. RESULTS: Thirty-three participants were interviewed; ages ranged from 57 to 86 years. Participants included 10 discontinued patients and 23 patients who completed their AET course or were adherent to AET at the time of interviewing. Both adherent and discontinued patients reported symptoms throughout their AET treatment course, and both attributed symptoms to factors other than AET (e.g., older age and pre-existing comorbidities). However, discontinued patients were more likely to attribute symptoms to AET and to describe difficulty managing their symptoms, with some directly citing symptoms as the reason for discontinuing AET therapy. Conversely, adherent patients were more likely to describe the necessity of taking AET, despite symptoms. CONCLUSIONS: AET adherence was associated with beliefs about AET, symptom attribution, and symptom management. Routine symptom monitoring during AET and addressing both symptoms and patients' understanding of their symptoms may promote adherence to AET.

Self-reported distress and problems after treatment for gynecological cancer - Correlation between a short screening tool and longer measures of anxiety/depression and health-related quality of life.

INTRODUCTION: The National Comprehensive Cancer Network (NCCN) distress thermometer and problem list (DTPL) is a brief self-report screening measure for use in follow-up cancer care. The aims of this study were to explore the correlations between scores on the DTPL and scores on longer measures of anxiety/depression and health-related quality of life among women treated for gynecological cancer, and to define a cutoff score on the DT representing high levels of psychological distress in this patient group. MATERIAL AND METHODS: During outpatient visits, 144 women filled in the DTPL, the Hospital Anxiety and Depression Scale (HADS) and the RAND-36-Item Short Form Health Survey (RAND-36) between October 2019 and March 2020. We assessed the agreement between the DT-scores and the HADS scores, explored variables associated with high levels of distress on the DT, and studied the associations between DTPL-scores and scores of health-related quality of life (HRQoL) from RAND-36. RESULTS: In receiver operating characteristic curve analysis between the distress score from the DT and a HADS total score ≥15 (defining high levels of anxiety/depression symptoms), the area under the curve was 0.81 (95% CI: 0.74-0.89). Using a cutoff of ≥5 on the DT (scale 0-10), we found a balanced level of sensitivity (81%) and specificity (71%) towards a HADS total score of ≥15. The scores of distress and problems reported on the DTPL correlated significantly with the majority of HRQoL function scales from RAND-36. CONCLUSIONS: The NCCN DTPL can be used as a screening measure for self-reported distress and problems after treatment for gynecological cancer. A score of ≥5 on DT may indicate high level of anxiety/depression as measured by HADS. The tool may help identify patients in need of referral to supportive care and rehabilitation facilities.

Predictors of significant distress in cervical cancer patients: a cross sectional study.

PURPOSE: This cross-sectional study aims to investigate parameters that predict relevant levels of distress in women in a perioperative setting undergoing treatment for cervical cancer. MATERIALS AND METHODS: Data from 495 patients with cervical cancer that were treated at the university hospital Aachen between 2010 and 2022 were analysed based on their respective National Comprehensive Cancer Network (NCCN) Distress Thermometer score (DT) and Problem List (PL) and their clinical history. 105 patients were enrolled in the study. 18 medical and demographic variables were analysed using multivariate logistic regression. RESULTS: Three variables contributed significantly to the prediction of a DT score ≥ 5. Significant distress was defined as a DT score of ≥ 5, which was observed in 70.5% of the participants (mean: 5.58 ± 2.892). Women who chose to receive psycho-oncological counselling were more likely to have a DT score ≥ 5 (Odds Ratio(OR) = 3.323; Confidence Interval (CI95%): 1.241-8.900; p-value: 0.017). In addition, women who did not receive chemoradiation had significantly higher DT scores (OR = 3.807; CI 95%:1.185-12.236; p-value: 0.025), as did women whose Distress Thermometer was assessed in the first month after their initial diagnosis (OR = 3.967; CI 95%:1.167-13.486; p-value: 0.027). CONCLUSION: Increased distress in women with cervical cancer is common especially in the first month after diagnosis, in patients who do not receive chemoradiation and in patients who seek psycho-oncological counselling. Surgical factors do not play a major role in patient distress.

Adaptation and validation of moral distress thermometer in Chinese nurses.

BACKGROUND: Moral distress seriously affects professional nurses, and a number of instruments have been developed to measure the level of moral distress. The moral distress thermometer (MDT) is one of the commonly used instruments that can rapidly measure real-time moral distress; however, it remains unclear whether it is still useful in the Chinese cultural context. AIM: This study aimed to adapt and validate the MDT among Chinese registered nurses. RESEARCH DESIGN: An online, cross-sectional, survey study of adapting and validating Chinese version of MDT. PARTICIPANTS AND RESEARCH CONTEXT: A total of 182 registered nurses effectively finished this survey. The correlation between MDT score and the score of the moral distress scale-revised version (MDS-R) was used for evaluating convergent validity, and MDT scores of registered nurses who working in different departments and who made different actions to the final question of the MDS-R were compared by using one-way ANOVA to evaluate construct validity. ETHICAL CONSIDERATIONS: The Ethics Committee of Chongqing Traditional Chinese Medicine Hospital approved this study. RESULTS: The Chinese version of MDT was described as relevant to measure moral distress, with a reported item-level content validity index (I-CVI) and scale-level CVI (S-CVI) of 1. The mean MDT score and mean MDS-R score were 2.54 and 38.66, respectively, and the correlation between these two scores was significantly moderate (r = 0.41). Nurses working different departments reported different levels of moral distress, and those working in intensive care unit reported the highest level of moral distress than those working in other departments (p = 0.04). The MDT scores between nurses who presented different actions to their position were also significantly different, and those who had ever left and those who had considered leaving but did not leave reported significantly higher moral distress. CONCLUSION: The MDT is a reliable, valid, and easy-to-use instrument to rapidly measure the real-time moral distress of registered nurses in China.

Assessment of emotional distress in palliative care: Edmonton Symptom Assessment System-revised (ESAS-r) vs Distress Thermometer.

OBJECTIVES: To evaluate the sensitivity and specificity of the Distress Thermometer (DT) as a screening tool for emotional distress in oncological palliative care patients and to compare the DT with the Edmonton Symptom Assessment System-revised (ESAS-r) and the gold standard to determine the most appropriate assessment method in palliative psychological care. METHODS: Data were collected from psychological screening tests (ESAS-r and DT), and clinical interviews (gold standard) were conducted by a clinical psychologist specialist in palliative oncology from January 2021 to January 2022 in an oncology palliative care service. RESULTS: The sample consisted of 356 first-time patients with a diagnosis of advanced cancer in palliative care. The most frequently reported oncological diagnoses were gastrointestinal tract (49.3%) and breast (18.3%). Most patients were female (n = 206; 57.9%), 60.4% were married/with a partner, 55.4% had between 6 and 9 years of schooling, and a median age of 57 (range, 46-65) years. The cutoff of the DT was 5, with a sensitivity of 75.88% and specificity of 54.3%. Emotional problems (sadness and nervousness) had a greater area under the curve (AUC) when measured using the DT than the ESAS-r; however, only in the case of the comparative sadness and discouragement was the difference between the AUC marginally significant. SIGNIFICANCE OF RESULTS: The use of the DT as a screening tool in oncological palliative care is more effective in the evaluation of psychological needs than the ESAS-r. The DT, in addition to evaluation by an expert psychologist, allows for a more comprehensive identification of signs and symptoms to yield an accurate mental health diagnosis based on the International Classification of Diseases-11th Revision and/or Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition.

Evaluating the capacity of the distress thermometer to detect high fear of cancer recurrence.

OBJECTIVES: Fear of cancer recurrence (FCR) is common and burdensome to patients, but often remains undetected. Oncology professionals report need for tools to improve FCR detection in routine care. Oncology care guidelines recommend the Distress Thermometer (DT) for distress screening, but it has not been validated for FCR. This study evaluated the capacity of the DT and accompanying problem list to detect FCR. METHODS: Amalgamated data of two studies with 149 breast cancer and 74 colorectal cancer survivors were used. We evaluated the Dutch DT including the DT score, problem list fears item and emotional domain score using Receiver Operating Characteristic analyses. The Dutch Cancer Worry Scale-6 (CWS-6) was used as reference measure, with validated cut-off scores ≥10 and ≥12 for high FCR. Sensitivity, specificity, negative and positive predictive values were calculated. RESULTS: The DT score showed poor performance in discriminating between low and high FCR. The recommended cut-off ≥4 had low sensitivity (65% for CWS-6≥10; 72% for CWS-6 ≥12) and specificity (67% and 58%). No other cut-off had an acceptable combination of sensitivity and specificity. The fears item had low sensitivity (29% and 44.9%) and high specificity (95% and 94%). The emotional domain score had fair performance in discriminating between low and high FCR but there was no cut-off with acceptable sensitivity and specificity. CONCLUSION: The DT as currently recommended in oncology care guidelines is not suitable to effectively detect FCR in routine care. To improve patients access to psychosocial care, it should be investigated how FCR-specific measures can be integrated in oncology practice.

A mixed-methods study to inform development of a caregiver-specific problem list for cancer distress screening.

OBJECTIVE: Oncology guidelines for distress management recommend use of the single-item distress thermometer (DT) and accompanying Problem List (PL) to identify patients with high distress levels and their potential sources of distress. However, oncology practices have yet to establish standardized protocols to screen and triage caregivers with high distress levels. With an eye toward integrating caregiver-centered support services into cancer care, this mixed-methods study sought to assess caregiver distress and challenges that may contribute to their distress. METHODS: Nineteen caregivers of metastatic breast cancer patients (60% female, 47% ethnic/racial minority) completed an interview and a survey comprised of the DT, the original 39-item PL, and five additional caregiver-specific PL items. RESULTS: Caregivers reported moderate distress levels and more than half exceeded the National Comprehensive Cancer Network (NCCN) cut-off, denoting significant distress. There was no association between caregiver distress and the number of items endorsed on the original PL. Qualitative analysis identified nine problem domains as areas of caregiver unmet need needs (i.e., practical challenges, caregiving responsibilities, social/relationship issues, caregiver and patient emotional well-being, caregiver and patient physical well-being, spiritual well-being, and communication). Two of the problem domains (caregiving responsibilities and communication) were not captured in any way by the original PL. CONCLUSION: With further research and development, the identified domains could serve as the basis for a caregiver-specific PL to facilitate triage and referral when incorporated as part of routine distress screening.

Initiation of distress screening in oral cancer clinics in Sri Lanka.

OBJECTIVE: This paper describes the initiation of distress screening in oral cancer clinics, among patients with oral cancer in Sri Lanka, addressing the service gap of lack of psychosocial oncology services. This involved validation of the Sinhala version of the Distress Thermometer (DT) and Problem List (PL) as an adjustment disorder (AD) screening tool. METHODS: The DT and PL were translated into the Sinhala language and cross-culturally adopted by the "modified Delphi" technique. The judgment validity was obtained through face, content, and consensual validation. The criterion validation of DT was performed among 95 oral cancer patients from two oro-maxillofacial-oncological hospitals in Sri Lanka, against the AD diagnosis of two consultant psychiatrists. RESULTS: The DT and the PL revealed good judgment validity. The optimal cut-off point of DT was 4 with a sensitivity of 91.8% (95% CI = 80.8%-96.8%), specificity of 78.3% (95% CI = 64.4%-87.7%), positive predictive value of 0.81 (95% CI = 0.53%-1.1%) and negative predictive value of 0.90 (95% CI = 0.2%-1.7%). The test re-test reliability of DT was excellent (Kappa coefficient 0.894). The area under the curve was 0.843. The PL demonstrated poor internal consistency in practical problems (KD-20 = 0.4), social problems (KD-20 = 0.3) and spiritual problems (KD-20 = 0.6). CONCLUSIONS: The Sinhala version of DT and PL were deemed a valid AD screening tool for patients with oral cancer in Sri Lanka to initiate distress screening in busy oral cancer clinics. However, further validation for the full spectrum of distress is needed, preferably with improvements to PL.

Work- and school-related distress among patients with cancer: Single-site retrospective chart review.

OBJECTIVES: To (1) describe the prevalence of work- or school-related distress among patients with cancer and (2) compare overall distress among those impacted at work or school to overall distress among those not impacted at work or school. DESIGN: Retrospective chart review. PARTICIPANTS: All patients visiting the study site March 2016-December 2020 who completed the NCCN Distress Thermometer and Problem List. METHODS: Descriptive statistics examined work- or school-related distress across patient characteristics and compared mean Distress Thermometer scores between patients with and without work- or school-related distress. FINDINGS: Among 1,760 unique patients, 7.5% reported work- or school-related distress at one or more visits. Rates were highest among patients seen for neurological (14.1%), skin (10.6%), and gastrointestinal (9.2%) cancers. Those reporting work- or school-related distress had higher overall distress scores (mean = 4.76; SD = 2.52) than others (mean = 3.37; SD = 2.92) (g=-0.482; t=-5.327, p < 0.001). CONCLUSIONS: Although the prevalence of work- or school-related distress was low in this sample, the magnitude of this distress emphasizes the importance of having effective resources available for patients with cancer who experience work- or school-related problems. IMPLICATIONS: More research is needed to understand how well distress screening processes identify and support patients with work- or school-related problems.

A systematic review of the translation and validation methods used for the national comprehensive cancer network distress thermometer in non-English speaking countries.

OBJECTIVE: The National Comprehensive Cancer Network (NCCN) distress thermometer (DT) was developed as a brief screening tool for detecting distress in cancer patients. Conceptually, distress was considered a more acceptable and inclusive term than other psychological terms such as depression or anxiety. It is used extensively in the United States and other English-speaking countries. We aim to describe the translation and validation methods of the DT and describe the recommended cutoff scores used to identify cancer patients experiencing clinically significant distress. METHODS: Nine bibliographic databases were searched using keywords to identify original research studies for non-English speaking countries' cancer patients. Full articles were independently assessed for inclusion and data extraction by two authors. RESULTS: The review of 4442 articles yielded 39 articles that validated the DT. We identified 20 languages in 25 countries. In all but one country, investigators were able to agree upon a word or phrase that meant distress in their native language that was subsequently validated against standardized instruments. Asian, Middle Eastern and European counties recommended cutoff score of 4 or 5 to identify clinically significant distress; however, European Union countries had a range of 2 to 7. CONCLUSIONS: Use of the translated DT with non-English speaking cancer patients provides a simple and quick tool to identify high distress. Similar to NCCN, the cutoff score of 4 or 5 was suggested by 78% of the studies; however, more studies of different types of cancer and within and among more countries will strengthen a recommended global DT cutoff score.

Predictive value of the Distress Thermometer score for risk of suicide in patients with cancer.

PURPOSE: This study aimed to assess the association between the Distress Thermometer (DT) score and risk of suicide in patients with cancer. In addition, we aimed to determine the best cutoff score to predict patients at risk of suicide. METHODS: From 2015 to 2016, we retrospectively collected data on patients with cancer. DT scores were collected, and the association between DT score and risk of suicide (suicide ideation or death ideation) was analyzed. Furthermore, receiver operating characteristic (ROC) analysis was performed to identify the appropriate cutoff score for predicting risk of suicide. RESULTS: A total of 260 patients with cancer were included, and suicidal ideation was identified in 33 cases referred for psychological intervention. The DT scores of the patients with suicidal ideation were significantly higher than those of patients without suicidal ideation (6.30±2.11 vs. 4.29±1.72, p<0.05). In addition, the area under the ROC curve for predicting risk for suicide was 0.758. The cutoff DT score of 3 had the highest sensitivity of 1.00 to rule out suicidal ideation, while 9 had the highest specificity of 1.00 to rule in suicidal ideation. Moreover, the appropriate cutoff DT score to predict patients with suicidal ideation was 5, with a sensitivity of 0.52, specificity of .84, positive likelihood ratio of 3.24, and negative likelihood ratio of 0.58. CONCLUSION: The DT score may be a helpful clinical tool to evaluate emotional distress and risk of suicide in patients with cancer. Clinically, for DT scores greater than 5 in patients with cancer, the risk of suicide greatly increases. In view of the DT's widespread use internationally by non-mental health clinicians in cancer to guide the need for specialist mental health interventions, its potential utility in also predicting suicide risk is of great interest.

Patient-reported distress and problems among elderly patients with hematological malignancy in Korea.

PURPOSE: Treatment for hematological malignancies (HMs) and functional decline associated with age can cause distress in elderly patients with HMs. However, information about the nature and effects of distress in this population is scarce. Therefore, this study examined the level of distress, its source, and the practical/familial/physical/emotional problems among elderly patients with HMs. METHODS: We conducted a cross-sectional study of patients with HMs aged ≥ 65 years who visited an outpatient clinic at a tertiary medical center in Korea between November 2019 and March 2020. Patient-reported distress and problems were measured using the distress thermometer (DT) and 39-item Problem List by the National Comprehensive Cancer Network. Descriptive statistics, χ2 test or Fisher's exact test, and multivariate logistic regression analyses were conducted (N = 132). RESULTS: In total, 62.1% of patients had moderate to severe distress (DT score ≥ 4), experiencing an average of nine problems. Significant sources of distress on multivariate logistic analysis included problems with transportation, depression, and constipation, accounting for 47% of distress variance. Most patients had physical (97.0%) or emotional problems (79.5%). Among these, fatigue (60.6%), worry (59.8%), tingling (59.8%), difficulty with mobility (47.0%), and memory/concentration (40.2%) were the most frequently reported problems. CONCLUSIONS: Elderly patients with HMs have a high burden of distress, which is affected by different sources, compared with younger patients with solid tumors. Thus, in this population, assessment and management of distress need to be conducted considering the unique features of their source and burden. Further research on distress should consider the cancer type and population age.

Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach.

OBJECTIVES: To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process between 2012 and 2016 to identify barriers preventing sustainability. METHODS: In this sequential explanatory mixed methods study, we synthesized the results of 2 quantitative retrospective descriptive studies and 1 qualitative focus group study. To compare and analyze the data, we used thematic triangulation. RESULTS: Nurses screened 32% (N = 7034) of all newly admitted inpatients with the DT, and 47% of the screenings showed a distress level ≥5. Of these cases, 9.7% were referred to psycho-oncological services and 44.7% to social services. In 15.7% of these cases, nurses generated a psychosocial nursing diagnosis. In focus group interviews, nurses attributed the low screening rate to the following barriers: adaptation to patients' individual needs, patient-related barriers and resistance, timing, communication challenges, established referral practice, and lack of integration in the nursing process. SIGNIFICANCE OF RESULTS: To improve distress screening performance, the screening process should be tailored to patients' needs and to nurses' working conditions (e.g., timing, knowledge, and setting-specific factors). To gain more evidence on distress management as a basis for practical improvements, further evaluations of distress screening are required.

Quality of life and illness perceptions in patients with breast cancer using a fasting mimicking diet as an adjunct to neoadjuvant chemotherapy in the phase 2 DIRECT (BOOG 2013-14) trial.

PURPOSE: In the phase II DIRECT study a fasting mimicking diet (FMD) improved the clinical response to neoadjuvant chemotherapy as compared to a regular diet. Quality of Life (QoL) and illness perceptions regarding the possible side effects of chemotherapy and the FMD were secondary outcomes of the trial. METHODS: 131 patients with HER2-negative stage II/III breast cancer were recruited, of whom 129 were randomly assigned (1:1) to receive either a fasting mimicking diet (FMD) or their regular diet for 3 days prior to and the day of neoadjuvant chemotherapy. The European Organisation for Research and Treatment of Cancer (EORTC) questionnaires EORTC-QLQ-C30 and EORTC-QLQ-BR23; the Brief Illness Perception Questionnaire (BIPQ) and the Distress Thermometer were used to assess these outcomes at baseline, halfway chemotherapy, before the last cycle of chemotherapy and 6 months after surgery. RESULTS: Overall QoL and distress scores declined during treatment in both arms and returned to baseline values 6 months after surgery. However, patients' perceptions differed slightly over time. In particular, patients receiving the FMD were less concerned and had better understanding of the possible adverse effects of their treatment in comparison with patients on a regular diet. Per-protocol analyses yielded better emotional, physical, role, cognitive and social functioning scores as well as lower fatigue, nausea and insomnia symptom scores for patients adherent to the FMD in comparison with non-adherent patients and patients on their regular diet. CONCLUSIONS: FMD as an adjunct to neoadjuvant chemotherapy appears to improve certain QoL and illness perception domains in patients with HER2-negative breast cancer. Trialregister ClinicalTrials.gov Identifier: NCT02126449.

Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study.

BACKGROUND: In different cancer entities, several studies have shown the adverse effects of cancer on mental health, psychological well-being and the increased risk of high emotional distress in cancer patients. This study aims to analyze psychosocial distress levels and their relationship between sociodemographic parameters and selected items on the Distress Thermometer (DT) Problem List in head and neck squamous cell carcinoma (HNSCC) patients. PATIENTS AND METHODS: We assessed a total of 120 HNSCC patients using the Distress Thermometer (DT) Problem List. Distress scores (DTS) of 90 patients were available. A DTS of ≥ 5 on the visual analogue scale represents clinically relevant distress. Data analysis consisted of descriptive statistics, comparison of mean values for different DTS subcategories and correlation between DTS scores and parameters of tumor classification, sociodemographic variables and selected problems. RESULTS: Distress was present in 57.7% of the sample, with a total of 52 patients with a DTS  ≥ 5. The mean DTS was 4.7 (SD 2.4). Patients with newly diagnosed HNSCC had significantly higher DTS. Distress levels were significantly associated with sadness, general worries, anxiety, nervousness, sleeping disorders, mouth sores and fever. Out of the total sample, 6 patients and out of these 6 individuals, 5 patients with a DTS ≥ 5 requested referrals to psycho-oncological service. CONCLUSION: High distress levels were common in HNSCC patients but only few patients desired psycho-oncological care. Addressing patients' supportive care needs in routine clinical practice is essential to meet unmet needs of HNSCC patients and thus improve cancer care.

Reducing distress and depression in cancer patients during survivorship.

OBJECTIVE: Distress and depression are prevalent in cancer patients throughout survivorship and are associated with adverse outcomes. This study examines the association between outpatient psycho-oncology treatment and distress and depression in cancer patients. METHODS: This is a prospective observational study of adult patients with a primary diagnosis of cancer referred for psycho-oncology services. Patients were seen for two psycho-oncology visits in a single clinical setting with various qualified providers. Patients completed the distress thermometer and problem checklist (DT + PL) and the Patient Health Questionnaire (PHQ-9) at the beginning of their first and second visits and repeated the DT at the end of these visits. RESULTS: The analysis included 174 patients seen once and 69 patients seen twice. Patients were seen on average 2.5 years after diagnosis. Both visits were associated with significant reductions in distress (5.56 before and 3.85 after for visit 1, p < 0.001; 4.92 before and 3.43 after for visit 2, p < 0.001). There was a significant reduction in distress from baseline to after visit 2 (p < 0.001). Depression scores significantly decreased from the first to second visits (8.79-7.57; p = 0.002). CONCLUSIONS: Psycho-oncology services were associated with significant reductions in distress and depression, with scores after services no longer meeting criteria for clinically significant distress (DT scores ≥ 4) and depression (PHQ-9 scores ≥ 8) as they did at baseline. Reductions in distress and depression were not significantly associated with provider type, intervention or timing of diagnosis. These findings support the use of psycho-oncology services in cancer patients throughout survivorship.

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study).

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study) BACKGROUND: E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors. RESULTS: Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR= 0.51, 95% CI=(0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR=1.03, 95% CI=(1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI=(-3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI=(-5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI=(2.27, 4.15), p < 0.001). As nutrition status declined, the distress score increased (95%CI=(0.88, 1.68), p < 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems. CONCLUSION: Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.

Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting.

BACKGROUND: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. AIM: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. DESIGN: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. SETTING/PARTICIPANTS: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. RESULTS: The area under the curve was optimal using a Distress Thermometer cut-off score of ⩾6 for total distress and for anxiety, and a cut-off score of ⩾4 optimal when screening for depression. CONCLUSIONS: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of ⩾5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.

Screening for distress in women with gynaecological cancer: Adaptation of the distress thermometer for gynaecological oncology patients.

OBJECTIVE: Generic distress screening tools may not recognise the unique concerns reported in some cancer populations. The face and content validity of a screening tool derived from the National Cancer Comprehensive Network distress thermometer and problem list and adapted specifically for women with gynaecological cancer is presented. METHODS: Building on existing work, panels of clinicians and researchers, and focus groups with women treated for gynaecological cancer, developed a nuanced distress screening tool. RESULTS: The clinical reference group used an iterative process to reduce 54 items to 22 across four domains (practical/family/psychological/physical). These items were included in the draft tool, which was reviewed by two focus groups of long-term cancer survivors. Participants unanimously thought the tool was necessary though several changes were recommended. The final draft tool contained a global distress score and 25 items across the four domains. CONCLUSIONS: This measure provides a structured screening tool tailored to the concerns of women with gynaecological cancer, enhancing communication between clinicians and their patients about potentially identified and unrecognised sources of distress. Future research will focus on establishing sensitivity and specificity of this tool and further assessing its utility in clinical settings for all gynaecological cancers (including rare cancers like vulvar cancer).