Distress Thermometer Cut-off Score Research Articles

Performance of Distress Thermometer: A Study among Cancer Patients.

The Distress Thermometer accompanied with Problems List is a commonly used screening tool for psychosocial distress. However, it's cut-off score, performance and risk factors for psychosocial distress varies among studies. This is the first study conducted in Nepal to investigate the Distress Thermometer's screening properties, its optimal cut-off score and evaluating the prevalence of psychosocial distress and its risk factors. This cross-sectional study enrolled 162 heterogeneous cancer patients. The English form of the Distress Thermometer was translated to Nepali using a forward and backward translation method. Questionnaires including socio-demographic, clinical characteristics, the Hospital Anxiety and Depression Scale and Distress Thermometer accompanied with Problems List were filled. Receiver Operating Characteristic analysis of distress thermometer scores was evaluated against Hospital Anxiety and Depression Scale-Total (≥15). An Area Under the Curve, sensitivity, specificity, positive predictive value and negative predictive value were calculated at each Distress Thermometer cut-off score. Receiver Operating Characteristic analysis showed an excellent discriminating performance (Area Under the Curve =87.4%). A cut-off score of 4 on Distress Thermometer was established and it yielded sensitivity (88.9%), specificity (71.1%), positive predictive value (75.4%) and negative predictive value (86.5%) respectively. Furthermore, 55.6% of participants were distressed and emotional problems (odd ratio = 28.00), practical problems (odd ratio = 12.152) and physical problems (odd ratio = 2.397) were found to be significant risk factors for PD. PD is a global burden in cancer patients. The DT with a cut-off score of 4 accompanied with PL is valid instrument for screening PD in Nepali cancer patients. PL identified the problems that causes of PD.

A distress thermometer with a cutoff score of ≥ 6 is the optimal point to identify highly distressed patients with advanced cancer stages in resource-limited countries without palliative care services.

Although the distress thermometer (DT) scale has been widely validated and used in different cancer types and settings, an optimal cutoff score of DT is not defined to screen advanced cancer patients. The study aimed to define the optimal DT's cutoff score among advanced cancer patients in resource-limited countries without palliative care services and to assess the prevalence and factors associated with psychological distress among this population. A secondary analysis was performed. Three hundred seventy-nine patients were recruited from Palestine. Participants completed the DT and the Hospital Anxiety and Depression Scale (HADS). Receiver operating characteristic analysis (ROC) was used to define the optimal cutoff score for the DT against HADS-Total ≥15. Multiple logistic regression was utilized for identifying the factors associated with psychological distress of the DT. A DT cutoff score ≥ 6 correctly identified 74% of HADS distress cases and 77% of HADS non-distress cases, with a positive predictive value (PPV) and negative predictive value (NPV) of 97% and 18%, respectively. The prevalence of distress was found to be 70.7%, and the major sources of distress were related to physical (n = 373; 98.4%) and emotional problems (n = 359; 94.7%). Patients with colon (OR = 0.44, 95% CI: 0.31 - 0.62) and lymphoid cancers (OR = 0.41, 95% CI: 0.26 - 0.64) were less likely to have psychological distress than patients with other types of cancer, whereas patients with lung (OR = 1.80, 95% CI: 1.20 - 2.70) and bone cancers (OR = 1.75, 95% CI: 1.14 - 2.68) were more likely to experience it. A cutoff DT score of 6 appeared acceptable and effective for screening distress in patients with advanced cancer stages. Palestinian patients exhibited a high level of distress, and the high prevalence supports the argument of using a DT within the standard delivery of cancer care to identify highly distressed patients. These highly distressed patients should then be involved in a psychological intervention programme.

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

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. 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. 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 2to 7. 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.

Screening for Psychological Distress in Vietnamese Cancer Patients: An Evaluation of the Distress Thermometer.

BackgroundPsychological distress is prevalent in patients with cancer, negatively affecting their treatment and quality of life. Clinical guidelines recommended screening all cancer patients routinely for psychological problems using simple measures such as the Distress Thermometer (DT) and Problem List (PL). This study is the first research in Vietnam to identify the optimal DT cutoff point to screen distress and the relationship with PL items among cancer patients.Methods300 cancer patients were recruited from 10 departments at Vietnam National Cancer Hospital (K hospital) and completed the DT and PL. Participants also completed the Patient Health Questionnaire‐9 (PHQ‐9) and the Generalized Anxiety Disorder‐7 (GAD‐7) with standard cutoff scores for identifying significant depression and anxiety.ResultsReceiver operating characteristic (ROC) curve analyses showed that a DT cutoff score of 4 had an area under the ROC curve of 0.81 and 0.82 using the PHQ‐9 and GAD‐7 cutoff scores of 10 as the criterion, respectively. This indicated good overall accuracy. This cutoff also showed a sensitivity of 0.87 and 0.92 for PHQ‐9 and GAD‐7 total score defined cases, respectively. Both specificity values were 0.58. In terms of the PL, 164 distressed patients (54.7%) reported significantly more emotional problems, family issues, and practical and physical problem, implying various causes contribute to psychological distress among cancer patients.ConclusionsThe study showed that the DT with a cutoff of 4 accompanied with PL is a simple and effective instrument compared to previous, longer measures commonly used to detect psychosocial distress in Vietnamese cancer patients. This cutoff point also identified patients with problems contributing towards distress.

Facial Expression Recognition With Machine Learning and Assessment of Distress in Patients With Cancer.

To estimate the effectiveness of combining facial expression recognition and machine learning for better detection of distress. 232 patients with cancer in Sichuan University West China Hospital in Chengdu, China. The Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS) were used as instruments. The HADS included scores for anxiety (HADS-A), depression (HADS-D), and total score (HADS-T). Distressed patients were defined by the DT cutoff score of 4, the HADS-A cutoff score of 8 or 9, the HADS-D cutoff score of 8 or 9, or the HADS-T cutoff score of 14 or 15. The authors applied histogram of oriented gradients to extract facial expression features from face images, and used a support vector machine as the classifier. The facial expression features showed feasible differentiation ability on cases classified by DT and HADS. Facial expression recognition could serve as a supplementary screening tool for improving the accuracy of distress assessment and guide strategies for treatment and nursing.

The efficiency of distress thermometer in the determination of supporting needs for cancer inpatients

ABSTRACT Psychological distress scale is highly recommended for cancer patients’ care. Several psychological scales have been implemented in cancer outpatient clinics. However, the use of the psychological distress scale, particularly distress thermometer (DT), in the inpatient has not been reported. In this study, we report the efficacy of DT in the determination of cancer inpatients’ supporting needs. A total of 170 inpatients diagnosed with cancer have been enrolled in this study. Only 132 patients matched the inclusion criteria, while other cases were excluded because of other diseases associated with cancer. The standardized problem list (PL) and Hospital Anxiety and Depression Scale (HADS) were implemented in comparison with DT. Then, the cut-off score of DT was performed to identify clinically significant differences. The analysis of the receiver operating characteristic (ROC) curve revealed that a DT cut-off score of 4 displayed 0.76 under the ROC curve. Sensitivity showed 0.86 sensitivity for cut-off score 4 and a specificity of 0.56 relative to the HADS cut-off score (≥15). DT scores were found independent of medical variables such as cancer type and stage, recurrence, or metastasis. Clinical ECOG-SP showed a significant association with the DT cut-off score (P ≤ 0.05). Regarding PL, patients with scores above DT cut-off were suffering 21 of 40 problems in all categories. Furthermore, patients that scored above the DT cut-off significantly showed an association with high support needs. DT scale showed significant performance in the evaluation of psychological distress among cancer inpatients through the efficient determination of their support needs.

Is it the time to implement the routine use of distress thermometer among Egyptian patients with newly diagnosed cancer?

BackgroundThe distress thermometer (DT) is an effective tool for identifying distress among cancer patients worldwide. However, DT has not been studied in Egyptian patients. We aimed to study the prevalence of distress among Egyptian patients with different types of cancers using DT.MethodsA total of 550 patients with newly diagnosed hematological and solid cancers who were followed up at 3 Oncology Centers in Egypt were enrolled. They completed a sociodemographic and clinical status questionnaire, the DT and the Problem List (PL) scale.ResultsAt a DT cut-off score of ≥4, 46% of patients had significant distress, which was related to the tumor site and stage. The most frequent problems reported were treatment decision (64.4%), worry (47%), and fears (44.5%). In univariate logistic regression analysis, participants who had significant distress described 23 out of 36 problems in the practical, family, emotional, and physical areas. After adjustment to sociodemographic and clinical characteristics, multivariable analysis confirmed that insurance, depression, fear, sadness, worry, loss of interest in usual activity, and sleep were independent factors associated with significant distress in cancer patients.ConclusionsAlmost half of Egyptian patients newly diagnosed with cancer reported significant distress. Those who had significant distress described extra problems in the practical, family, emotional, and physical areas. We recommend the routine use of DT for screening Egyptian patients with cancer, as well as the involvement of the psycho-oncology and social services, at the time of their initial diagnosis.

A Systematic Review and Meta-analysis of the Distress Thermometer for Screening Distress in Asian Patients with Cancer.

The distress thermometer (DT) is a commonly used tool for screening distress in Asian patients with cancer. However, the optimal cut-off score and discriminative accuracy remain unclear. Hence, this meta-analysis aimed to examine its diagnostic value and optimal cut-off score in Asia. A systematic search was conducted in the PubMed, EMBASE and Cochrane Library databases. The pooled sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio were calculated. The area under the curve (AUC) was computed from the summary receiver-operating characteristic (SROC) curve. All analyses were performed using STATA 12.0 software. Finally, 10 studies describing 2851 patients were included. After pooling all the results from the 10 studies, the optimal DT cut-off score was 4 with a pooled sensitivity of 0.78 (95% confidence intervals (CI) 0.68-0.86), specificity of 0.73 (95% CI 0.65-0.80) and AUC of 0.82 (95% CI 0.78-0.85). When the DT was compared to the hospital anxiety and depression scale-total (HADS-T), the cut-off score of 4 showed the best balance between the pooled sensitivity (0.81, 95% CI 0.69-0.89) and specificity (0.74, 95% CI 0.59-0.84), and the AUC was 0.84 (95% CI 0.81-0.87). In conclusion, the DT with a cut-off score of 4 was an effective screening tool in Asian patients with cancer.

P106 Depressive symptoms and anxiety and their screening in IBD patients: performance of the distress thermometer in Italian IBD patients

Abstract Background Roughly 50% of patients with IBD have symptoms of psychological distress (Mikocka-Walus et al. 2019) but only 15.2% receive attention for their mental health although the effect on disease severity can be profound. It is necessary to have an easy-to-administer psychological distress screening tool. The distress thermometer (DT) is a single-item distress screening scale with 11-likert response widely used in oncological patients. The aim of study was to determine whether the single-item DT compared favourably with IBD clinical indices and time consuming measures currently used to screen for distress. Methods Two hundered and twenty IBD patients (51.43% male) who were recruited in eight Italian hospitals completed the DT and identified the presence or absence of 34 problems using standardised problem list (PL). They completed the 14-item Hospital Anxiety and Depression Scale (HADS) and the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ). Disease clinical indices have been collected for each patient (Mayo score, Harvey–Bradshaw Index–HBI, years of illness, and exacerbation in the last year). Using receiver operating characteristic (ROC) analyses validated the use of the DT in Italian IBD population. Results 47.6% reported anxiety and depression symptoms (HADS ≥15) and needs emotional care. Anxiety is much more associated (43.8%) than depressive problems (26.2%). Data are confirmed by responses to DT and PL: 44.5% of patients reported moderate–severe emotional distress (TD ≥ 5), 43.1% of patients report nervousness and worry, 27.1% reported depression. We observed a strong positive correlation between IBDQ and HADS (r = 0.74, p < 0.001) and DT (r = 0.58, p < 0.001), while there was a slightly smaller association with Mayo score (r = 0.46, p < 0.001) and HBI (r = 0.39, p < 0.001). There was not a statistical significant correlation between disease indices and the emotional distress as measured by HADS or DT. ROC analyses showed that a DT cutoff score of 5 or higher had optimal sensitivity (83%) and specificity (68%) relative to the HADS score as ‘gold’ standard. DT scores yielded area under the curve estimates relative to the HADS cutoff score indicative of good overall accuracy (AUC = 0.81–95% CI: 0.77–0.85). Conclusion Our study confirms that anxiety and depression symptoms are associated with IBD. This is the first study that demonstrated that DT is an easy-to-administer screening tool of psychosocial distress in IBD population. We propose that gastroenterologists use DT to identify patients with psychological distress: an early psychological support and a multidisclinar equipe can determinate a patient’s better disease course (Mawdsley et al. 2005). Our analyses indicated that using a DT’s cutoff of 5 to indicate high levels of distress.

The use of distress thermometer in advanced cancer inpatients with pain.

This study aimed to provide support for the extensive application of Distress Thermometer (DT) in advanced cancer inpatients with pain and explored factors associated with high DT scores among this population. Advanced cancer patients with pain were recruited from Department of Pain Relief in Tianjin Cancer Hospital and Institute, China. They completed the DT with problems list and HADS within 48h after admission. The cutoff score of DT was evaluated against Hospital Anxiety and Depression Scale (HADS) for its sensitivity and specificity by using receiver operating characteristic (ROC) curves. Multiple logistic regression model analysis was performed to investigate correlates of DT scores. Four hundred forty one inpatients with mixed diagnoses were recruited. Referring to the cutoff of 15 on HADS, DT cutoff score of 5 yielded AUC of 0.757, with an optimal sensitivity of 0.861 and specificity of 0.531. Using the cutoff scores of greater than or equal to 5, 70.5% of the patients were distressed. Logistic regression analysis of DT found that the breakthrough pain, poorer KPS, higher pain degree, and emotional problems were the predictive factor for current distress. DT is efficacious in screening for psychological distress in advanced cancer inpatients with pain. Psychological distress is prevalent with a cutoff score of greater than or equal to five. To better identify the distressed cancer patients with pain, pain degree, performance status, and emotional problems should be considered together.

Assessing psychological distress in cancer patients: The use of distress thermometer in an outpatient cancer/hematology treatment center

ABSTRACTThe purpose of this study is to assess the feasibility of the distress thermometer (DT) and the accompanying problem checklist (PC) as a screening tool for psychological distress and the sources of those distress at an outpatient cancer treatment center in Central California. Forty-three patients completed the DT and the PC. Based on a recommended DT cutoff score of 4, patients were classified as “distressed” (>4) and “not-distressed” (<4).Respondents ranged in age from 34 to 87 years (mean = 60.44, SD = 12.05), the majority of whom were female (55.8%). The most common types of cancer diagnosis were breast cancer, followed by blood abnormality (i.e., blood disorders), lung, and bladder cancer. Based on the recommended DT cutoff score, 51% of patients were identified as significantly distressed. Results showed significant difference on DT score between the distressed and not-distressed groups, t(41) = −4.25, p < .001. The most commonly reported sources of distress were in the practical, emotional, and physical domains of the PC list.Routine distress screening can significantly help improve identification of distress and the sources of the distress in cancer patients and enable healthcare professionals to facilitate appropriate psychosocial support and referrals. Implications for practice and research are discussed.

Using the patients concerns inventory for distress screening in post-treatment head and neck cancer survivors

PurposeCancer patients can experience significant distress during their cancer trajectory, which impacts upon clinical outcomes and quality of life. Screening for distress using holistic assessments can help identify and address unmet concerns/needs. The purpose of this study was to evaluate the relationship between concerns and distress, and the impact of distress on clinic outcomes in post-treatment head and neck cancer patients. Methods170 patients attending routine follow-up clinics were prospectively recruited. All patients completed the Patient Concerns Inventory (PCI) and the Distress thermometer (DT) at preconsultation. ResultsThe rate of significant distress (i.e. DT cut-off score ≥4) was 36% (62/170). Significantly distressed patients selected more items overall than patients without distress (mean, median (QR) of 5.40, 5 (2–8) vs 2.61, 2 (0–4), p < 0.001). Significant distress was most strongly associated with Physical and Functional well-being (p < 0.001) and Psychological and Emotional well-being domains (p = 0.001). On balance, very little difference was noted between cut-off points of either ≥4 or ≥5 PCI items of concern selected. Both cut-off points demonstrated an acceptable level of sensitivity, specificity and predictive values for significant distress. Consultations were longer with increasing numbers of concerns. ConclusionsJust over one-third of patients are significantly distressed. They were more likely to express a higher number of concerns. A cutoff score ≥4 or ≥5 PCI items selected can identify those at risk of significant distress. Concerns causing significant distress were related to emotional/psychological issues and physical function.

A Specific Distress Cutoff Score Shortly After Breast Cancer Diagnosis

High levels of distress are expected shortly after the diagnosis breast cancer. The Distress Thermometer (DT) is commonly used to screen for distress, using a cutoff score of 4 or 5; however, this score might not be appropriate for detecting distress in women with recently diagnosed breast cancer. The aims of this study were to establish the optimal DT cutoff score for detecting high distress shortly after breast cancer diagnosis and to correlate this score with the reported problems. We selected for this study Dutch women who completed the DT and the Hospital Anxiety and Depression Scale within 1 month after breast cancer diagnosis. Receiver operating characteristic analysis of DT scores was performed, with the Hospital Anxiety and Depression Scale being used as the criterion standard for the level of distress. The sensitivity, specificity, positive predictive value, and negative predictive value of each DT score were calculated. In total, 181 women participated in the study. The optimal DT cutoff score for detecting distress was 7 with a sensitivity of 0.73, specificity of 0.84, positive predictive value of 69%, and negative predictive value of 87%. Emotional problems were the most frequently reported concerns. We consider a cutoff score of 7, shortly after breast cancer is diagnosed, optimal to identify those women with high distress and therefore at risk of chronic distress. The findings are clinically important because they can enable healthcare professionals to direct their time and resources to those most in need of their assistance.

Screening for distress using the distress thermometer and the University of Washington Quality of Life in post-treatment head and neck cancer survivors

The primary aim was to determine the efficacy of the Distress Thermometer (DT) in screening for anxiety and mood problems against the University of Washington Quality of Life, version 4 (UWQOL). Secondary aims were to evaluate the association between demographic, clinical and health-related QOL variables with significant distress. Two hundred and sixty one disease-free HNC ambulatory patients attending routine follow-up clinics were prospectively recruited. Both DT and UWQOL were completed pre-consultation. Receiver operating characteristic (ROC) curve analyses of DT score for anxiety dysfunction yielded an area under the curve (AUC) of 0.877, with a sensitivity of 84% (43/51) and specificity of 76% (159/210) for a DT cut-off of ≥4; with a corresponding AUC of 0.825 for mood with sensitivity 78% (28/36) and specificity 71% (159/225). Treatment with radiotherapy and a longer consultation time were associated with significant distress (DT ≥4). Significant distress was also reported in two third of those reporting less than "Good" overall QOL. Distress levels were particularly associated with poor Social-Emotional function, more so than the association seen with poor physical function. DT is a reasonable screening tool for distress in the HNC population. The DT cut-off score ≥4 was effective in identifying those with significant distress. Significant distress is associated in survivors with poor health-related quality of life, those who received radiotherapy and patients who have longer consultation times in clinic.

Accuracy of the Distress Thermometer for home care patients with palliative care needs in Germany.

Our aim was to examine the accuracy of the German version of the Distress Thermometer (DT) compared with the Hospital Anxiety and Depression Scale (HADS) in patients with palliative care needs living at home. Ours was a 15-month cross-sectional study beginning in September of 2013 in Germany with consecutive patients cared for by a palliative home care service. The survey was implemented during the initial visit by a home care team. Patients were excluded if they were under 18 years of age, mentally or physically unable to complete the assessment questionnaires as judged by their healthcare worker, or unable to understand the German language. During the first encounter, the DT and HADS were applied, and sociodemographic and medical data were collected. A total of 89 persons completed both the HADS and DT questionnaires (response rate = 59.7%; mean age = 67 years; female = 55.1%; married = 65.2%; living home with relatives = 73.0%; oncological condition = 92.1%; Karnofsky Performance Scale [KPS] score: 0-40 = 30.3%, 50-70 = 57.3%, >80 = 6.7%). The mean DT score was 6.3 (±2.3), with 84.3% of participants scoring above the DT cutoff (≥4). The mean HADStotal score was 17.9 (±7.8), where 64% of participants had a total HADS score (HADStotal) ≥15, 51.7% reported anxiety (HADSanxiety ≥ 8), and 73% reported depression (HADSdepression ≥ 8). Using the HADS as a gold standard, a DT cutoff score ≥5 was optimal for identifying severe distress in patients with palliative care needs, with a sensitivity of 93.0%, a specificity of 34.4%, a positive predictive value (PPV) of 73.3%, and likelihood ratios LR+ = 1.42 (<3) and -LR = 0.203 (<0.3). The DT performed satisfactorily compared to the HADS in screening for distress in our study and can be employed as an instrument for identification of patients with distress. Consequent to the high prevalence of distress, we recommend its routine use for screening distressed persons at home with palliative care needs in order to offer adequate support.

Using Rasch analysis to examine the distress thermometer’s cut-off scores among a mixed group of patients with cancer

The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. The DT's recommended cut-off score of 4 or 5 has typically been established using the Hospital Anxiety and Depression Scale (HADS) by receiver operating characteristic curve analysis. The present analysis complements these studies by critically examining the use of the HADS to identify the DT's cut-off score and corroborating the DT's cut-off scores using item response theory (Rasch analysis). The DT and HADS were completed by 340 patients with cancer. Rasch dimensionality analysis was performed on the HADS-Total, and test characteristic curves were examined to equate the DT and the HADS subscales. Identified DT cut-off scores were then examined for their sensitivity and specificity. Rasch analysis did not support the unidimensionality of HADS-Total. The test characteristic curves indicated that a cut-off score of ≥8 on the HADS-Anxiety and HADS-Depression subscales was equivalent to a score of 6 and 7 on the DT, respectively. However, a DT cut-off score of 5 resulted in the best balance between sensitivity and specificity across the HADS-Anxiety and HADS-Depression subscales. Despite being a popular practice, the present findings did not support combining the HADS-Anxiety and HADS-Depression subscales to identify the DT's cut-off score. Furthermore, these results inform the use of the DT as a preliminary screening tool and suggest that when a single screen is used, a DT cut-off score of 6 or 7 might be more appropriate than the typical cut-off score of 4.

The Distress Thermometer as an ultra-short screening tool: A first validation study for mixed-cancer outpatients in Singapore

IntroductionResearch has shown that single-item tools, like the Distress Thermometer (DT), are comparable to longer ones, like the Hospital Anxiety and Depression Scale (HADS). In this study, we tested the validity of the DT in a population of Singapore cancer outpatients, and determined the cut-off scores on the DT for clinically relevant distress and an impaired quality of life (QOL). We also documented the prevalence of anxiety, depression, and QOL impairments in this population. MethodsOne hundred and five patients (Mdn age=51–60years, 64% female, and 71% Chinese) diagnosed with various cancers participated in this study. They completed a standard socio-demographic form, the DT and the Problem List, the HADS, and the EuroQOL Quality of Life Scale (EQ-5D). ResultsAlmost a third of patients had clinically significant emotional distress, with 15%–16% having probable levels of anxiety and depression. Almost half (41%–55%) had an impaired QOL compared to Singapore population norms. Receiver operating characteristic curve analyses identified an area under the curve of 0.89 (SE=0.36, 95% CI [0.82, 0.96], p<.001) when compared to the HADS cut-off score of 15. A cut-off score of 5 on the DT had the best sensitivity (0.88) and specificity (0.81). Participants above the DT cut-off score of 5 reported significantly more emotional problems (worry, nervousness, depression, sadness), insurance/finance-related problems, and sleep problems. They also scored significantly lower on EQ-5D, with more QOL impairments in the domains of carrying out their usual activities and anxiety/depression. ConclusionLevels of distress, anxiety, depression, and QOL impairments are high in this population. The DT was found to be a valid tool for distress screening in the Singapore cancer population, with a recommended cut-off score of 5.

Measurement of distress and its alteration during treatment in patients with nasopharyngeal carcinoma

We examined the criterion-related validity of the Distress Thermometer (DT) for screening distress in patients with nasopharyngeal carcinoma (NPC) and investigated prospectively how distress changes. In the cross-sectional study, the DT was tested against the Hospital Anxiety and Depression Scale (HADS) in 295 patients with NPC. In the prospective study, 61 newly diagnosed patients with NPC completed the DT and HADS 6 times. Adopting HADS as the standard tool for screening distress, 31.5% of the patients with NPC had distress. A DT cutoff score ≥ 4 had best sensitivity (0.73) and specificity (0.85). In the prospective study, the proportion of patients with distress rose significantly during treatment. Receiver operating characteristic (ROC) findings provide initial support for the validity of the DT among patients with NPC. Nearly one third of patients with NPC exceeded cutoff values for distress in the cross-sectional study. In the prospective study, the level of distress increased significantly during concurrent chemoradiotherapy for patients with NPC.

Sensitivity and Specificity of the Distress Thermometer in Screening for Distress in Long-Term Nasopharyngeal Cancer Survivors

The Distress Thermometer (dt) is a screening tool recommended to quickly identify cancer patients with distress. Our study aimed to examine the sensitivity and specificity of the dt in detecting psychological distress in long-term Chinese nasopharyngeal cancer (npc) survivors. Data for the 442 participating npc survivors were collected through a self-administered questionnaire based on the dt and the Hospital Anxiety and Depression Scale (hads). The hads was used to define cases of psychological distress. Positive and negative groups were defined based on 4 hads criteria (Anxiety, Depression, Anxiety or Depression, and overall score). Receiver operating characteristic (roc) curves were used to examine the ability of all possible cut-off values of the dt to detect positive and negative cases. For each roc curve, the area under the curve (auc) was used as an indicator of the overall accuracy of the dt to identify positive cases of distress. The positive auc values [with 95% confidence intervals (ci)] for the 4 hads criteria were 0.715 (95% ci: 0.667 to 0.764), 0.714 (95% ci: 0.661 to 0.768), 0.724 (95% ci: 0.677 to 0.771), and 0.724 (95% ci: 0.664 to 0.775) respectively. At a cut-off score of 4, the sensitivity of the dt to the four hads criteria was, respectively, 0.366 (95% ci: 0.296 to 0.436), 0.448 (95% ci: 0.364 to 0.532), 0.362 (95% ci: 0.299 to 0.425), and 0.421 (95% ci: 0.339 to 0.502), and the specificity of the dt to the 4 hads criteria was, respectively, 0.860 (95% ci: 0.818 to 0.902), 0.860 (95% ci: 0.821 to 0.899), 0.854 (95% ci: 0.814 to 0.894), and 0.854 (95% ci: 0.814 to 0.894). At a cut-off score of 5, the corresponding sensitivities were lower than those at the cut-off score of 4. All potential cut-off scores showed poor sensitivity (<0.90). The roc analysis showed poor discrimination. No potential dt cut-off score had an acceptable sensitivity. The dt showed poor sensitivity in npc survivors. Thus, the dt might not be a valid scale for psychological distress screening in long-term Chinese npc survivors.

Comparing the distress thermometer (DT) with the patient health questionnaire (PHQ)-2 for screening for possible cases of depression among patients newly diagnosed with advanced cancer

Distress screening guidelines call for rapid screening for emotional distress at the time of cancer diagnosis. The purpose of this study was to examine the distress thermometer's (DT) ability to screen in patients in treatment for advanced cancer who may be depressed. Using cross-sectional data collected from patients within 30 days of diagnosis with advanced cancer, this study used ROC analysis to determine the optimal-cutoff point of the distress thermometer (DT) for screening for depression as measured by the physician health questionnaire (PHQ)-9; inter-test reliability analysis to compare the DT with the PHQ-2 for screening in possible cases of depression, and multivariate analysis to examine associations among the DT emotional problem list (EPL) items with cases of depression. The average age of the 123 patients in the study was 59.9 (12.9) years. Seventy (56.9%) were female. All had Stage 3 or 4 cancers (40% gastrointestinal, 19% gynecologic, 20% head and neck, 21% lung). The mean DT score was 4 (2.7)/10; and 56 (43%) were depressed as measured by the PHQ-9 ≥ 5. The optimal DT cut-off score to screen in possible cases of depression was ≥ 2/10, with a sensitivity of .96, compared to a sensitivity of .32 of the PHQ-2 ≥ 2. Correlation coefficients for the DT ≥ 2 and the PHQ-2 with the PHQ-9 ≥ 5 were 0.4 and -0.2, respectively. EPL items associated with cases of depression were Depression (OR = 0.15, 0.02-0.85) and Sadness (OR = 0.21, 0.06-0.72). The optimal DT threshold for identifying possible cases of depression at the time of diagnosis is ≥ 2; this threshold is more sensitive than the PHQ-2 ≥ 2. EPL items may be used with the DT score to triage patients for evaluation.