The Distress Thermometer: Cutoff Points and Clinical Use

Abstract

To establish an optimal cutoff point for the National Comprehensive Cancer Network’s Distress Thermometer (DT) as a screening measure to identify and address psychological distress in individuals with cancer, and to examine whether distress as measured by the DT significantly changes across the treatment trajectory. Secondary analyses of baseline data from a longitudinal parent study examining a computerized psychosocial assessment. Three diverse comprehensive cancer centers across the United States. 836 patients with a current or past diagnosis of cancer. Study participants were selected from a randomized clinical trial. Patients during any stage of the cancer treatment trajectory were recruited during a chemotherapy infusion or routine oncology appointment. The Behavioral Health Status Index and the DT were administered and compared using receiver operating characteristic analyses. Results support a cutoff score of 3 on the DT to indicate patients with clinically elevated levels of distress. In addition, patients who received a diagnosis within the 1–4 weeks prior to the assessment indicated the highest levels of distress. Providers may wish to use a cutoff point of 3 to most efficiently identify distress in a large, diverse population of patients with cancer. In addition, results indicate that patients may experience a heightened state of distress within 1–4 weeks postdiagnosis compared to other stages of coping with cancer. Using a brief measure of distress can help streamline the process of screening for psychosocial distress.