Distress Thermometer Score Research Articles

Symptom Burden, Quality of Life, and Distress in Acute Myeloid Leukemia Patients Receiving Induction Chemotherapy: Results of a Prospective Electronic Patient-Reported Outcomes Study

Background: Induction chemotherapy for acute myeloid leukemia (AML) is more intensive than many other cancer treatments, and may be associated with a different symptom burden. Little is known about the most prevalent symptoms during AML induction, nor how they change over time, and with remission status. Similarly, little is known about the trajectory of quality of life (QoL) and distress scores in this population. We aimed to learn more about the natural history of these issues via a prospective, longitudinal, observational patient-reported outcomes study.Methods: We enrolled 43 inpatients with AML at initiation of induction chemotherapy, and assessed their symptoms, quality of life (QoL), and distress weekly during their month-long hospitalization for induction, and monthly thereafter, using 3 validated instruments: Patient Care Monitor v2.0 (PCM); Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu); and NCCN distress thermometer (DT). We used descriptive statistics and ANOVA to analyze results.Results: Mean age of study participants was 59.4 (SD 13.4); 21 (49%) were female. Patients were mostly high-risk for recurrence, with 25 (58%) being ≥60 years old, 19 (44%) having high-risk cytogenetics, and 10 (23%) having relapsed disease. Among relapsed patients, the mean number of prior treatments was 2.7 (SD 1.3). At the time of this analysis, 5 patients (18%) had gone on to receive a stem cell transplant. As expected, symptoms were most prominent during the second and third weeks of treatment. However, across all 4 weeks of induction patients consistently reported 5 symptoms at a moderate or severe level (scores of 4 to 6, or 7 to 10 out of 10, respectively), including: poor appetite (35%), dry mouth (37%), difficulty sleeping (38%), dysgeusia (44%), and fatigue (56%). Other prominent moderate-to-severe symptoms included diarrhea (35%), daytime sleepiness (30%), and nausea (27.5%), despite standard supportive care. Mean QoL by FACT-Leu worsened substantially from week 1 (121.8, SD 27.6) to week 2 (108.2, SD 26.3), and then slowly recovered thereafter, improving to better than baseline by month 3 and continuing to improve throughout 1-year of follow-up (p<0.01; see Figure 1). The mean distress score across all 4 weeks of induction was 4 (SD 3.2), which is the threshold for recommended referral to additional support services, but was higher in week 1 (4.4; SD 3.5) compared to week 4 (3.0; SD 3.1). Grouping patients by remission status based on bone marrow assessments done between 30 and 45 days post-induction, QoL and DT scores appear markedly different, and diverge at this point (Figures 2 and 3), such that patients with persistent disease after induction have progressively worse QoL and more distress compared to patients in remission.Conclusion: AML patients receiving induction chemotherapy face a significant symptom burden, impaired QoL, and moderate psychological distress. Several of the most prevalent and severe symptoms during induction may be amenable to further targeted intervention. Longitudinal QoL and distress scores diverge markedly on the basis of post-induction remission status, suggesting that further targeted interventions may be needed to address the greater burden of issues among patients with relapsed disease. The overall prevalence and severity of symptom, QoL, and distress issues suggests sizeable unmet palliative care and psychosocial needs among patients with AML. [Display omitted] [Display omitted] [Display omitted] DisclosuresLeBlanc:Flatiron: Consultancy; Epi-Q: Consultancy; Boehringer Ingelheim: Membership on an entity's Board of Directors or advisory committees; Helsinn Therapeutics: Honoraria, Research Funding. Abernethy:Flatiron: Employment.

Carers of patients with high-grade glioma report high levels of distress, unmet needs, and psychological morbidity during patient chemoradiotherapy.

Few studies have explored the unmet needs of carers of people with high-grade glioma. We aimed to determine carers' levels of distress during treatment, understand their support needs and explore predictors of distress. Carers of people with high-grade glioma undergoing chemoradiotherapy were recruited to this prospective, longitudinal cohort study. Carers completed the validated Supportive Care Needs Survey, Brain Tumour Specific Supportive Care Needs Scale, Distress Thermometer (DT), and General Health Questionnaire (GHQ-12). Questionnaires were administered during patients' chemoradiotherapy and 3 and 6 months later. We recruited 118 carers who were mainly female (72%) and caring for spouse (82%). The mean age was 53 years (SD = 13.6; range, 21-89). Thirty-one percent of carers reported moderate distress (DT score 5-6/10) and 31% reported extreme distress (score 7-10/10) during combined chemoradiotherapy. Carer distress was associated with adverse GHQ scores (r = 0.61, P < .001). Seventy-two percent reported a negative financial impact of caring and 51% of those previously working full-time had taken leave or reduced working hours. The top 5 moderate/high unmet needs were: accessing prognostic information; accessing financial support and government benefits; accessible hospital parking; impact of caring on usual life; reducing stress in the patients' life. Carers reported substantial distress, and high distress levels were correlated with greater psychological impact and increased self-reporting of unmet needs. Future research should focus on interventions that aid in reducing carer distress.

Screening for Psychological Distress in Adult Primary Brain Tumor Patients and Caregivers: Considerations for Cancer Care Coordination.

This study aimed to assess psychological distress (PD) as scored by the Distress Thermometer (DT) in adult primary brain tumor patients and caregivers (CGs) in a clinic setting and ascertain if any high-risk subgroups for PD exist. From May 2012 to August 2013, n = 96 patients and n = 32 CG underwent DT screening at diagnosis, and a differing cohort of n = 12 patients and n = 14 CGs at first recurrence. Groups were described by diagnosis (high grade, low grade, and benign) and English versus non English speaking. Those with DT score ≥4 met caseness criteria for referral to psycho-oncology services. One-way ANOVA tests were conducted to test for between-group differences where appropriate. At diagnosis and first recurrence, 37.5 and 75.0% (respectively) of patients had DT scores above the cutoff for distress. At diagnosis, 78.1% of CGs met caseness criteria for distress. All CGs at recurrence met distress criterion. Patients with high-grade glioma had significantly higher scores than those with a benign tumor. For patients at diagnosis, non English speaking participants did not report significantly higher DT scores than English speaking participants. Psychological distress is particularly elevated in CGs and in patients with high-grade glioma at diagnosis. Effective PD screening, triage, and referral by skilled care coordinators are vital to enable timely needs assessment, psychological support, and effective intervention.

Editorial: PsychOncology: clinical psychology for cancer patients—Cancer: the key role of clinical psychology

Editorial: PsychOncology: clinical psychology for cancer patients—Cancer: the key role of clinical psychology

Optimal Frequency of Psychosocial Distress Screening in Radiation Oncology.

To accurately hypothesize the optimal frequency of psychosocial distress screening in patients undergoing radiation therapy using exploratory modeling of prospective data. Between October 2010 and May 2011, 71 RT patients underwent daily screening with the Distress Thermometer. Prevalences of Distress Thermometer scores ≥ 4 were recorded. Optimal screening frequency was evaluated by planned post hoc comparison of prevalence rates and required screening events estimated by numerical modeling, consisting of data point omission to mimic weekly, every-other-week, monthly, and one-time screening intervals. Dependence on clinical variables and chronologic trends were assessed as secondary end points. A total of 2,028 daily screening events identified that 37% of patients reported distress at least once during the course of treatment. Weekly, every-other-week, monthly, and one-time screening models estimated distress prevalences of 32%, 31%, 23%, and 17%, respectively, but required only 21%, 12%, 7%, and 4% of the assessments required for daily screening. No clinical parameter significantly predicted distress in univariable analysis, but "alone" living situation trended toward significance (P = .06). Physician-reported grade 3 toxicity predicted distress with 98% specificity, but only 19% sensitivity. Thirty-seven percent of radiation oncology patients reported distress at least once during treatment. Screening at every-other-week intervals optimized efficiency and frequency, identifying nearly 90% of distressed patients with 12% of the screening events compared with daily screening.

Psychological screening of onco-hematologic inpatients: Distress Thermometer administration.

The screening of psychological distress is a milestone in psycho-oncology. The National Comprehensive Cancer Network has established clinical guidelines for detecting and managing it and the Distress Thermometer (DT) was the recommended tool for the screening. Although its utility for oncologic patients has been reported frequently in the literature, less is known about hematologic patients. The present study involves a sample of onco-hematologic adult patients. In the current study, we proposed the Distress Thermometer and the Problem List in a sample of hematologic inpatients at Ca' Foncello Hospital, Treviso, Italy. We evaluated 102 patients, 61% male and 39% female, median age 59 years (range 18-78). Enrolled patients had acute leukemia (31%), multiple myeloma (31%), or lymphoma (31%). A total of 41.6% of the patients presented psychological distress, and the DT score was associated with neither sex nor diagnosis. The psychological distress was mild in 21.8%, moderate in 13.8%, and severe in 12.9% of the patients. Our results were consistent with previous results regarding the validation process of DT in a large sample of Italian cancer patients.

Abstract P5-15-11: The distress screening tool: Initial experience with electronically curated patient reported measures

Abstract Background: In June 2013, our health system transitioned to an electronic medical record (EMR) which included collecting patient quality of life data at each clinic visit. We used the NCCN distress thermometer (DT), a short, simple to use, self-report measure which uses a 10-point scale from 0 (no distress) to 10 (extreme distress) as well as an associated problem checklist which queries the source(s) of their distress. Among our breast cancer clinic population, we studied the severity and sources of distress as well as whether the DT score was associated with stage at diagnosis and time interval since diagnosis. Methods: Between October 1, 2013 and April 30, 2014, starting 3 months after implementation of a comprehensive EMR, all patients seen at our tertiary breast cancer clinic were asked to complete the DT survey at each clinic visit. DT data were collected and entered into the EMR at point of care. The DT tool was correlated with demographic and tumor information from our prospectively curated electronic datamart. Results: We collected 7276 DT surveys from 3267 unique patients over seven months. Median age of the cohort was 60 years; 73% were white and 21% were black. Among those with available staging data and a diagnosis of breast cancer, stage distribution was 10% stage 0, 34% stage I, 37% stage II, 15% stage III and 4% stage IV. The median reported distress score was 1.0 (range 0-10) with score distribution shown in Figure 1. The most commonly reported source of stress was fatigue (8.0%) followed by pain (6.8%). For new patient appointments the most commonly reported sources were worry (9.5%) followed by nervousness (8.0%). There was no significant correlation between overall distress score and stage at diagnosis. Among patients who were seen more than once during the study interval, the DT score changed for 33.7% of patients. The lowest distress scores were reported among women &amp;gt;3 years from initial diagnosis. Conclusions: The transition to an integrated EMR system has allowed collection of analyzable patient reported data to inform medical and psychosocial intervention. Structured data collection at point of care allows for efficient identification of and management for the major sources of distress among patients during breast cancer treatment and survivorship. Citation Format: Shelley Hwang, Steve Power, Ilona Stashko, Rachel Blitzblau, Rachel Greenup, Janet Horton, Kellly Westbrook, Kimberly Blackwell, Heather Sperling, Jeffrey Peppercorn, Gretchen Kimmick, Kelly Marcom. The distress screening tool: Initial experience with electronically curated patient reported measures [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-11.

Evaluation of the status of psychosocial distress in nasopharyngeal carcinoma patients and analysis of its influencing factors

Objective To investigate psychosocial distress status of hospitalized patients with nasopharyngeal carcinoma and then analyze its influencing factors. Methods Using the method of convenience sampling, the level of psychosocial distress of hospitalized patients with nasopharyngeal carcinoma was measured with psychosocial distress thermometer (DT), then by orderly classification Logistic regression analysis methods, the main factors affecting the degree of psychosocial distress were obtained. Results This study included 235 patients, and 228 patients completed the survey effectively, DT score was (4.030±2.993) points, including DT < 4 points (mild pain) accounted for 36.8% (84/228), DT 4-6 points (moderate pain) accounted for 38.2% (87/228), DT≥7 points (severe pain) accounted for 25.0% (57/228). Regression analysis showed that the economic problems, emotional problems (depression, fear, sadness), body problems (eating, oral ulcer, sleep problems), age, education degree, stressful life events in the recent year, the time of disease diagnosis, and disease recurrence were the main factors influencing the degree of psychosocial distress. Conclusions Hospitalized patients with nasopharyngeal carcinoma have widespread psychosocial distress, clinical medical personnel should take individualized psychological evaluation and intervention according to the related factors of psychosocial distress in order to reduce the degree of psychosocial distress. Key words: Nasopharyngeal neoplasms; Psychosocial distress; Influencing factors

Psychosocial distress screening implementation in cancer care: an analysis of adherence, responsiveness, and acceptability.

The American College of Surgeons Commission on Cancer has mandated implementation of a systematic protocol for psychosocial distress screening and referral as a condition for cancer center accreditation beginning in 2015. Compliance with standards requires evidence that distress screening protocols are carried out as intended and result in appropriate referral and follow-up when indicated. The purpose of this study was to examine the fidelity of distress screening protocols at two tertiary cancer treatment centers. A retrospective review and analysis of electronic medical records over a 12-week period examined clinic adherence to a prescribed distress screening protocol and responsiveness to patients whose scores on the National Comprehensive Cancer Network Distress Thermometer (DT) indicated clinically significant levels of distress requiring subsequent psychosocial contact. A weekly online survey assessed clinician perspectives on the acceptability of the protocol. Across clinics, rates of adherence to the distress screening protocol ranged from 47% to 73% of eligible patients. For patients indicating clinically significant distress (DT score ≥ 4), documentation of psychosocial contact or referral occurred, on average, 50% to 63% of the time, and was more likely to occur at one of two participating institutions when DT scores were high (DT score of 8 to 10). Clinician assessments of the protocol's utility in addressing patient concerns and responding to patient needs were generally positive. Systematic tracking of distress screening protocols is needed to demonstrate compliance with new standards of care and to demonstrate how well institutions are responding to their clinical obligation to address cancer patients' emotional and psychosocial needs.

Sleep status of cervical cancer patients and predictors of poor sleep quality during adjuvant therapy.

This study was designed to detect the prevalence of poor sleep quality in cervical cancer patients before and after adjuvant therapy, determine whether the prevalence of poor sleep quality in cervical cancer patients is higher than that in the general population, and analyze the factors associated with poor sleep quality. A total of 76 stages I and II cervical cancer patients and 116 female residents completed the Pittsburgh Sleep Quality Index (PSQI). Patient Neurotoxicity Questionnaire (PNQ), Distress Thermometer (DT), Multidimensional Fatigue Inventory, and Hospital Anxiety and Depression Scale were used to measure the patients' chemotherapy-induced peripheral neurotoxicity (CIPN), psychological distress, fatigue, anxiety, and depression. Data on social support and exercise were collected by the questionnaire. Logistic regression was used to identify the factors associated with poor sleep quality. Prevalence rates of poor sleep quality were 27.59 % for female residents, 52.63 % for patients before adjuvant therapy, and 64.50 % for patients after adjuvant therapy. The distributions of the PSQI scores of the patients before (Z = 3.814, P < 0.001) and after (Z = 5.957, P < 0.001) adjuvant therapy were different from those of the residents. The difference in the PSQI scores before and after adjuvant therapy among cervical cancer patients was significant (P = 0.007). The factors associated with poor sleep quality were high DT score (P = 0.045), depression (P = 0.028), anxiety (P = 0.027), high PNQ grade (P = 0.016), and chemotherapy + radiotherapy treatment (P = 0.017). Exercise was a protective factor for poor sleep quality (P =0.019). The prevalence of poor sleep quality in stages I and II cervical cancer patients was approximately twice than that of women in the communities. Cancer treatment considerably affected sleep quality. Psychological distress, depression, anxiety, and high grade of CIPN during adjuvant therapy were factors associated with poor sleep quality. Exercise during adjuvant therapy could reduce the risk of poor sleep quality.

Assessing the Preparatory Grief in Advanced Cancer Patients (PGAC) instrument in an American population.

225 Background: Only 50% of cancer patients who screen positive on the Distress Thermometer accept referral to psychosocial resources and mainly for challenges coping with overwhelming emotional response to losses. The Preparatory Grief in Advanced Cancer (PGAC) instrument was shown to have significant associations with hopelessness, anxiety, and depression in a Greek population with favorable potential as a screening tool. We aimed to assess the use of the PGAC in a sample of American patients diagnosed with incurable cancer as a more efficient screening tool for patients who would benefit from additional psychosocial referrals. Methods: We conducted this survey with participants from Northwestern University in Chicago, IL. Participants were US citizens and &gt;18 years old with an incurable cancer and no history of substance abuse or current psychiatric diagnosis. Patients were asked to complete a single survey composed of demographic data and scales including the PGAC, Distress Thermometer, HADS, ESAS and QOL. We used pair-wise correlation measurements, which included p-value measurements for testing whether the correlation coefficient was significantly different from 0. We then used pair-wise correlation coefficients to assess for p-value &lt; 0.05 at different PGAC scores. Results: 53 patients were surveyed, of which 57% (30) were outpatients. The PGAC score was associated with the distress thermometer (R=0.74, p=&lt;0.001), HADS (R=0.65, p=&lt;0.01), and ESAS (R=0.49, p=&lt;0.01) as well as inversely correlated with QOL score (R=-0.45, p=&lt;0.001). Additionally, PGAC &gt; 21 (p=0.02) was associated with elevated distress thermometer score (p=0.02) and elevated HADS scores (p=0.04). Conclusions: We tested the PGAC in an American population for the first time and found correlation between PGAC other validated measures (Distress Thermometer, ESAS, HADS, QOL) in an American population. We propose a PGAC cutoff of &gt;21 to assess for preparatory grief due to its association with elevated scores on Distress and HADS scales above this threshold. This instrument may better identify patients struggling with coping who would benefit from additional support but further investigation is needed.

Symptom burden, quality of life, and distress in acute myeloid leukemia patients receiving induction chemotherapy: A prospective electronic patient-reported outcomes study.

167 Background: Induction chemotherapy for acute myeloid leukemia (AML) is more intensive than many solid tumor treatments, and may be associated with a different symptom burden. Little is known about the most prevalent symptoms during AML induction, nor how they change over time. Methods: We enrolled AML inpatients at initiation of induction chemotherapy, and assessed their symptoms, quality of life (QoL), and distress weekly during their month-long hospitalization for treatment, using 3 validated instruments: Patient Care Monitor v2.0 (PCM); Functional Assessment of Cancer Therapy–Leukemia (FACT-Leu); and NCCN distress thermometer (DT). Here we report results from the first 16 enrolled patients, using standard descriptive statistics. Results: Mean age of study participants was 59.6 (SD 12.2), and most were newly diagnosed with AML (SD 87.5%, n=14). Patients were mostly high-risk for recurrence, with 50% (8) being &gt;60 years old and 71% (10) having high-risk cytogenetics. Fatigue was the most prevalent symptom, with an average of 59% of patients reporting moderate to severe fatigue at each assessment. The other most prevalent moderate/severe non-functional symptoms were dysgeusia (50%), dry mouth (42%), diarrhea (41%), decreased appetite (37.5%), insomnia (37.5%), daytime sleepiness (36%), nausea (36%), hair loss (36%), and mouth sores (34%). Median QoL by FACT-Leu total score decreased substantially between weeks 1 and 2 (118.5 to 104.5); the most substantial decrements were in subscales for personal well-being and functional well-being (20.5 to 14.5, and 13.5 to 8.5, respectively). QoL did not return to baseline by week 4. Median DT score at baseline was 6.5, with a trend towards weekly improvements in distress (DT = 3 at week 4). Depressive symptoms like hopelessness and sadness were reported by an average of 25% and 31.3% of patients, respectively. Conclusions: AML patients receiving induction chemotherapy have significant symptom burden, impaired QoL, and psychological distress. The prevalence of these issues suggests sizeable unmet palliative care and psychosocial needs in AML patients receiving induction chemotherapy.

Health risk assessment of head/neck cancer patients.

81 Background: Effective methods of screening head and neck cancer patients for health risk behaviors are needed. Methods: The present study assessed 452 cancer patients with an assessment that covered the following domains: psychological distress, smoking status, nutritional intake, functional activity level and need for support services. Thirty six out of the 452 patients recruitedfrom radiation oncology carried a diagnosis of head/neck cancer. Results: Patients with head/neck cancer had higher levels of depressive symptoms measured by the Patient Health Questionnaire (PHQ9) with mean scores of 6.3 (SD=4.8) compared to the scores of patients with other cancer diagnoses (mean PHQ9 score= 4.3, SD=5.4) p=.04. Twenty percent of head/neck patients had PHQ9 scores greater than 12 and 52% had a distress thermometer score of &gt;4. Head/neck patients were more likely to be current smokers or have quit since diagnosis (31%) compared to patients with other diagnoses (16%) p=.02. Head/neck patients were more likely to be male 68% (p&lt;.001). When asked if they would like services from any of the following practitioners, 29% requested a nutritionist, 14% requested a social worker and 25% requested integrative medicine services. None of the smokers with head/neck cancer requested services from the smoking cessation counselors compared to 25% of smokers with other cancer diagnoses. In the sample of head/neck patients, 73% of smokers were likely to endorse feeling “worry, fear or nervousness” compared to 33% of non-smokers (p=.04). Referrals were facilitated with an automated email to the clinician within 2 days of the assessment. Conclusions: Head/neck patients in this sample are more likely to have depressive symptoms and to have health risks such as smoking. Smokers are less likely to be receptive to smoking cessation counseling. Cumulatively, these data suggest that the needs of head/neck cancer patients are distinct and this diagnostic group may benefit from enhanced survivorship services both during treatment and to follow.

Family caregivers' distress levels related to quality of life, burden, and preparedness.

Family caregivers (FCGs) caring for loved ones with lung cancer are at risk for psychological distress and impaired quality of life (QOL). This study explores the relationship between FCGs' distress, per the distress thermometer (DT) and FCGs' QOL, burden, and preparedness. The purpose is to identify types of problems unique to FCGs in cancer care. Family caregivers of patients diagnosed with non-small cell lung cancer were recruited from an adult outpatient setting at a comprehensive cancer center. Questionnaires included demographic information, City of Hope QOL Scale-Family Version, Caregiver Burden Scale, FCG preparedness, and DT. Baseline data were utilized for this analysis. Of the FCGs (N = 163), 68% were spouses, 64% female, and 34% worked full-time. FCG age ranged from 21 to 88 years with a mean of 57 years. FCGs cared for patients with non-small cell lung cancer stage I-III (44%) and stage IV (56%). Psychological distress (DT mean = 4.40) was moderate. DT scores were highly correlated with seven of the eight explanatory variables. Secondary principal components analysis of the explanatory variables combined correlated variables into three constructs identified as self-care component, FCG role component, and FCG stress component. Simultaneous multiple regression of distress onto the three components showed they accounted for 49% of the variance in distress. This exploration of FCGs' concerns associated with elevated distress scores, as measured by the DT, helped identify three component problem areas. These areas warrant further psychosocial assessment and intervention to support FCGs as they care for the patient with cancer.

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.

The Neurobiological Basis of the Distress Thermometer: A PET Study in Cancer Patients

The objective of this study was to investigate the possible associations between the Distress Thermometer (DT) scores and the brain metabolism of structures involved in stress response. Twenty-one cancer patients were assessed using the DT, Problem Checklist and Hospital Anxiety and Depression Scale (HADS). The psychological measures were correlated with [18 F]PET-FDG brain glucose metabolism. Multiple and linear regression and binary logistic regression were run to analyse data. The DT and HADS scores illustrated that 48% of patients were distressed, 19% were depressed and 48% were anxious. Results showed that some subcortical areas activity, such as part of midbrain and of hypothalamus, was correlated with the DT scores. The Problem Checklist scores correlated with the activity of the same areas and included more regions in the limbic forebrain and brainstem. Compared with the DT and Problem Checklist, HADS-Depression scores showed a more extensive pattern of correlation with brain activity, including limbic and cortical areas. The results highlighted that the DT scores correlated with the activity of brain areas typically involved in stress response. Indeed, hypothalamus metabolism was found to be the best predictor of distressed patients.

Posttraumatic growth and psychological distress in Chinese early‐stage breast cancer survivors: a longitudinal study

To describe the dynamic changes in posttraumatic growth (PTG) and psychological distress in hospitalized early-stage breast cancer (BC) survivors over a 6-month period. A longitudinal study design was adopted. The PTG inventory (PTGI) and distress management screening measure were used 3 months after diagnosis, then again at 6 and 9 months after diagnosis. For baseline data, 155 BC patients who were receiving chemotherapy were selected from four first-class tertiary hospitals in Beijing from April 2010 to March 2011 using a purposive sampling method. Of these, 120 BC patients completed the follow-up investigation. A repeated measures analysis of variance, followed by least significant difference post-hoc analysis, was used to compare PTG and psychological distress. The total score of the PTGI was 62.72 ± 14.66 in BC survivors at 3 months after diagnosis.There was a weak negative relationship between PTG and psychological distress (r = –0.282, p<0.001).PTG increased and psychological distress decreased from 3 to 9 months after diagnosis. The PTGI scores were 63.24 ± 14.21, 68.26 ± 15.29, and 70.29 ± 16.07 at 3, 6, and 9 months after diagnosis, respectively, with distress thermometer scores of 3.62 ± 1.98, 2.59 ± 2.00, and 2.51 ± 1.00, respectively. At 3 months after diagnosis, BC survivors develop PTG at a low level while they are receiving chemotherapy. PTG showed a weak negative association with psychological distress. The level of PTG shows an increasing tendency, whereas the degree of psychological distress exhibits a downward trend in the 9 months after diagnosis.

Postsurgical screening for psychosocial disorders in neurooncological patients

The diagnosis of a brain tumor can cause severe psychosocial distress, which can have a variety of negative consequences on patients' physical and mental well-being. The detection of psychosocial distress in daily clinical routine is difficult and subsequent referral to mental health professionals is rare. The aim of this study was to determine the incidence of psychological disorders of patients early postoperatively and to investigate both the Hornheide Screening Instrument (HSI) and Distress Thermometer (DT) as screening tools in neurooncological practice. One hundred and thirty-four patients with brain tumors of different histology were postoperatively evaluated by the Distress Thermometer and Hornheide Screening Instrument. Additionally, correlation to gender, age, localization of the tumor, Karnofsky performance score and tumor entity were analyzed. After initial surgery 36 patients (26.9 %) showed pathologic results in the HSI and 50 patients (36.7 %) were severely distressed (DT Score≥6). Women had the highest rate of psychological disorders, followed by patients suffering from gliomas and meningiomas. Further highlighting the results of both tests, over 80 % of those patients who scored pathologically in both tests were in need of professional psychiatric help due to depression. Both the DT and HSI are suitable instruments for identifying patients in psychological distress after brain tumor surgery in neurooncological routine. Our results confirm that nearly one third of patients are unable to overcome the difficulties facing the diagnosis of a brain tumor in this early situation and should be supported by mental health professionals.

Early Screening in Patients With Head and Neck Cancer Identified High Levels of Pain and Distress

Pain and distress are recognized as the fifth and sixth vital signs in cancer care, respectively, as debilitating symptoms that are frequently under-recognized. The aim of this study was to document, using touch-screen technology, levels of pain and distress in patients with head and neck cancer before their assessment at a head and neck multidisciplinary referral clinic. A cross-sectional study over a 4-year period (2008 through 2011) was conducted for patients attending a head and neck oncology multidisciplinary team clinic in the Hunter New England referral district of Australia. Predictor variables were cancer stage and site. Cancer sites divided into 8 different regions, with distinction made for cutaneous versus noncutaneous sites. Outcome variables consisted of pain and distress levels. Pain was assessed using a Numerical Rating Scale of 0 to 10, and distress was assessed using the Distress Thermometer and PSYCH-6 scales. In the context of a screening study and for statistically comparing pain with other variables, pain was regarded as any score higher than 0. Clinically significant distress represented a Distress Thermometer score higher than 3 and a PSYCH-6 score of at least 3. Data analysis consisted of descriptive statistics, variance contrasts, and 2-tailed Pearson correlations. Four hundred thirty-six patients were included in the study, with an equal number of cutaneous and noncutaneous cancer sites. Thirty-four percent of patients reported having pain, and 13% had clinically significant distress. Tumor stage did not significantly affect pain or distress scores. There is a high level of pain and distress reported by patients with head and neck cancer before their assessment and management is discussed.

Correlates of elevated distress thermometer scores in breast cancer patients

Distress is prevalent in breast cancer patients and can be detrimental to quality of life, performance status, treatment adherence, and satisfaction with medical care. The National Comprehensive Cancer Network developed the distress thermometer (DT) as a self-assessment tool for screening distress in cancer patients. Given time and financial constraints, it is important to refine screening criteria to identify patients with elevated risk for distress. In this study, we identify clinical and epidemiological factors that are associated with an increased likelihood of elevated DT scores (≥ 4 and ≥ 7). We assessed 229 female patients with the DT at their initial consultation for breast cancer at the Huntsman Cancer Hospital between September 2007 and December 2008. Descriptive statistics and logistic regression models were used to analyze DT and patient data. Patients undergoing their initial distress thermometer screening within 30 days of receiving a diagnosis of breast cancer had the highest likelihood of scoring ≥ 4 and ≥ 7 on the DT screening tool. Emotional and physical concerns were associated with scores ≥ 4 and scores ≥ 7. Spiritual concerns became significant in patients reporting scores ≥ 7. Patients who were non-Caucasian, unemployed, had a prior history of depression, presented for recurrent disease, or who had been recently diagnosed had a higher likelihood of scores ≥ 4 and scores ≥ 7. Four groups of patients should be targeted for aggressive screening; patients with a prior diagnosis of depression, patients presenting with recurrent disease, unemployed patients, and non-Caucasian patients. Interventions should address physical, emotional, and spiritual concerns.