Abstract
Objective We aimed to examine the performance of the distress thermometer (DT) and identify the prevalence and risk factors associated with psychological distress (PD) in heterogeneous cancer patients. Methods This cross-sectional study enrolled 1496 heterogeneous cancer patients from the inpatient and outpatient departments. Receiver operating characteristic analysis (ROC) of DT was evaluated against the Hospital Anxiety and Depression Scale-Total (HADS-T ≥15). An area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and clinical utility index were calculated. Multiple binary logistic regression was used to identify the factors associated with PD. Results Referring to ROC analysis, DT showed good discriminating accuracy (AUC = 0.88). A cutoff score of 4 was established, and it yielded sensitivity (0.81), specificity (0.88), PPV (0.87), NPV (0.82), and clinical utility indexes (screening utility = 0.71 and case-finding utility = 0.73). 46.5% of our participants was distressed. Lower education levels (odd ratio (OR) = 1.39), advanced stage (OR = 1.85), active disease status (OR = 1.82), lack of exercise (OR = 3.03), diagnosis known (OR = 0.64), emotional problems (OR = 3.54), and physical problems (OR = 8.62) were the predictive factors for PD. Conclusion DT with a cutoff score (≥4) is a comprehensive, appropriate, and practical initial screener for PD in cancer patients. Predicting factors should be considered together for effective management of PD in such population.
Highlights
Anxiety and depression are common after a cancer diagnosis. ough anxiety and depression are different clinical entities, they are generally referred to as psychological distress (PD)
Identification and treatment of PD are beneficial in reducing its negative consequences among cancer patients [4]. erefore, the National Comprehensive Cancer Network (NCCN) Guidelines for Distress Management recommend that every cancer patient should be screened for PD and managed [5]
Screening tool is an initial investigation of a disease or condition. ere are various screening tools for PD such as the Hospital Anxiety and Depression Scale (HADS), Brief Symptom Inventory-18 (BSI-18), Symptom Checklist-90, and other psychiatric interview tools. ese tools are lengthy, time-consuming, and bothersome for patients to complete. erefore, the NCCN Distress Management Panel and available studies recommend the use of the distress thermometer (DT) as a screening tool for PD. e DT is ultrashort, easy to use, and Journal of Oncology nonstigmatizing for the patients [5,6,7]
Summary
Anxiety and depression are common after a cancer diagnosis. ough anxiety and depression are different clinical entities, they are generally referred to as psychological distress (PD). Anxiety and depression are common after a cancer diagnosis. Erefore, the National Comprehensive Cancer Network (NCCN) Guidelines for Distress Management recommend that every cancer patient should be screened for PD and managed [5]. Erefore, the NCCN Distress Management Panel and available studies recommend the use of the distress thermometer (DT) as a screening tool for PD. Is raises the question as to whether one comprehensive optimal cutoff score to distinguish PD in general cancer patients regardless of the clinical setting (inpatient and outpatient) and cancer types is needed. Us, this study aimed to (1) evaluate the performance and determine a comprehensive DT cutoff score to measure PD in heterogeneous cancer patients and (2) investigate the prevalence and factors associated with PD in these populations Available studies (Table 1) are limited by clinical settings (inpatient) and insufficient study population that may not effectively represent the overall cancer population [12, 20,21,22,23,24]. is raises the question as to whether one comprehensive optimal cutoff score to distinguish PD in general cancer patients regardless of the clinical setting (inpatient and outpatient) and cancer types is needed. us, this study aimed to (1) evaluate the performance and determine a comprehensive DT cutoff score to measure PD in heterogeneous cancer patients and (2) investigate the prevalence and factors associated with PD in these populations
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