Distress Thermometer Research Articles

Understanding Barriers and Distress Experienced Among Cancer Patients: Analysis from an Urban Academic Emergency Department.

The purpose of this study was to examine barriers and facilitators to compliance for cancer care in patients utilizing an emergency department (ED)-based assessment. Adult ED patients who either had active cancer or a history of cancer were enrolled between August 2020 and Jan 2022 for this prospective cohort study. We piloted the National Comprehensive Cancer Network (NCCN) Distress Thermometer. Multivariable regression analyses were used to assess the predictors of high distress. Of the 152 patients enrolled, 73% were Black patients, 11% were non-Hispanic White, and 16% included patients from other racial and ethnic groups (including 10.5% Hispanic patients); 73% of the sample had active cancer. The current ED visit was cancer related for 44%. The mean score on the Distress Thermometer was 4 (SD = 2; range 0-8) with 30% having a high distress level of ≥ 6. Having an active cancer and race/ethnicity were significant predictors of high distress. Patients who had active cancer had three times (aOR = 3.01; 95% CI 1.12-8.10) higher odds of experiencing high distress in the past week compared to those who did not have active cancer, after adjusting for race/ethnicity and reason for visit. Practical problems and physical problems were the most common, with 43% (n = 66) and 40% (n = 61) of the patients reporting these problems, respectively. Despite significant progress in cancer care, cancer patients/survivors face difficulty in transitioning between care environments and end up seeking episodic care in the ED and experience a high level of distress.

Abstract CT293: eCAN Project : The EU Joint Action on strengthening eHealth including telemedicine and telemonitoring for cancer prevention and care

Abstract The integration of telemedicine tools such as teleconsultation and telemonitoring in cancer patients care may allow to improve person-centered care and patients’ empowerment. The eCAN JA (https://ecanja.eu/) explores the role of telemedicine tools in clinical trials focusing on tele-rehabilitation and tele-psychological support in different populations of cancer patients in 10 European countries.The main aim is to assess the effect of teleconsultation and telemonitoring program focused on rehabilitation and psychological support for cancer patients on patient reported outcomes measures (PROMs) in three different pilot randomized controlled trials. MethodsThe pilot trials have been launched in September 2023 in 10 European countries with a multicentric, prospective, randomized, open label design in patients affected by Breast Cancer (BC) (Pilot 1a), Head and Neck (H&N) (Pilot 1b) and advanced cancer (Pilot 2). According to the sample size calculation, the aim is to enroll a minimum of 354 patients, in 18 European cancer centers. Patients are randomly assigned either to the intervention or control group using a 1:1 ratioThe main objectives of the pilots are: 1-To assess the effect of teleconsultation program and telemonitoring focused on rehabilitation for patients with BC (1a) and H&N (1b) cancer on the PROMs (quality of life (QoL) and pain) compared to usual care.2-To assess the effect of teleconsultation program and telemonitoring focused on psychological support for patients with advanced cancer (pilot 2) on the PROMs (QoL and distress thermometer) compared to usual care. Patients in the intervention group receive weekly teleconsultation during 8 weeks through the secure Edumeet platform. In pilot 1, tele-rehabilitation training is performed by a remote physiotherapist and consist of a series of revalidation exercises. In pilot 2, tele-psychological support is performed by a remote psychologist and consist of techniques for managing emotions and stress.PROMs data will be collected longitudinally during the intervention with dedicated digital application (eCAN app) and distant Telemonitoring with eCAN dashboard. Patients in the control group receive usual (in person) care. Results64/354 patients have been enrolled at present. An interim analysis is planned for the end of January 2024 in order to assess feasibility, patients compliance and dropout rate.. ConclusionThe integration of telemedicine tools such as teleconsultation and telemonitoring may allow to improve person-centered care and patients’ empowerment. The results of the eCAN project will improve our knowledge on benefits and risks for teleconsultation and telemonitoring in cancer patients care and will facilitate health care professionals’ skills in communication with patients and their families in the context of remote care and telemedicine. Co-funded by the European Union (Grant number: 101075326). Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA. Neither the European Union nor the granting authority can be held responsible for them. Citation Format: Andrea Pace, Vittorio Castaldo, Marco G. Paggi, Efthyvoulos Kyriacou, Christina Plomariti, Magdalena Rosinska, Tugce Schmitt, Victoria Leclercq, eCAN WP5 research team. eCAN Project : The EU Joint Action on strengthening eHealth including telemedicine and telemonitoring for cancer prevention and care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT293.

ASSESSMENT OF THE LEVEL OF DISTRESS AND PRACTICAL AND FAMILY PROBLEMS IN PATIENTS WITH ONCOLOGICAL DISEASES

Purpose: To study and analyze the relationship between patients’ practical and family problems and the level of distress. Material/Methods: A “Distress Thermometer” was used to collect information from the patient to assess the degree of distress. Inclusion and exclusion criteria for the patients were applied. Methods for statistical processing of the data and interpretation of the results were used. Results: The study included 225 patients with an average age of 59.6 (+/- 11.4 years). Women are a little over half, 56% (n=126) of the total number of those examined. All patients have a histologically confirmed oncological diagnosis in stage II, III and IV. It was found that there was no relationship between the level of distress and childcare (p= 0.93). In a more in-depth analysis of the results, a significantly higher level of distress was found in patients who encountered difficulties with transportation to the medical facility (p=0.01). A significantly higher level of distress was reported in patients who marked the relationship with their partner as problematic (n=13, 5.8%) (4.7±3.9). Conclusion: The diagnosis and treatment of cancer have more than just a physical impact. Health care should be comprehensive based on the needs of the patient. It is also necessary to consider the psycho-social and emotional support provided by medical professionals.

Perioperative psychological distress in patients with intracranial tumors; a single center study.

Distress Thermometer (DT) was adopted to evaluate distress in neuro-oncology on a scale from 1 to 10. DT values above 4 indicate major distress and should initiate psycho(onco)logical co-therapy. However, data about peri-operative distress is scarce. Hence, we evaluated peri-operative distress levels in a neurosurgical patient cohort with various intracranial tumors using the DT. We conducted a retrospective study including inpatients with brain tumors who underwent surgery in our department between October 2015 and December 2019. Patients were routinely assessed for distress using the DT before or after initial surgery. A comparative analysis was performed via Wilcoxon rank-sum test. 254 patients were eligible. Mean DT value of the entire cohort was 5.4 ± 2.4. 44.5% (n = 114) of all patients exceeded DT values of ≥ 6. In our cohort, poor post-operative neurological performance and occurrence of motor deficits were significantly associated with major distress. When analysed for peri-operative changes, DT values significantly declined within the male sub-cohort (6.0 to 4.6, p = 0.0033) after surgery but remained high for the entire cohort (5.7 and 5.3, p = 0.1407). Sub-cohort analysis for other clinical factors revealed no further significant changes in peri-operative distress. Distress levels were high across the entire cohort which indicated a high need for psychological support. Motor deficits and poor post-operative neurological performance were significantly associated with DT values above 6. Distress levels showed little peri-operative variation.

Patient-Reported Outcomes in Hematopoietic Stem Cell Transplant Recipients: Design, Implementation, and Pilot Results

Background: Patient-reported outcome measures (PROMs) offer a collaborative opportunity between the patient and the care team to improve the quality of care. Objectives: To define PROMs in patients receiving hematopoietic stem cell transplant (HSCT), a pre-visit questionnaire (PVQ) was developed, which included a single agenda-setting question, the PROMIS-29 survey, and the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT). Study Design: Patients completed the PVQ 1 month prior to transplant (baseline) and at 1, 3, 6, and 12 months following transplant. Results: Sixty-five patients (n = 27 allogenic; n = 38 autologous) participated. Survey completion rates were 95% at 1 month post-transplant, 74% at 6 months, and 65% at one year. One month following transplant, patients’ fatigue (P < .001) increased, while physical (P < .001) and social (P < .001) functions decreased. Each returned to baseline at 3 months (P < .001). Fatigue was more pronounced in allogeneic recipients (P = .017) and autologous recipients recovered physical function much sooner (P = .021). Conclusions: This study confirms the feasibility of capturing PROMs longitudinally in patients receiving HSCT and demonstrates significant changes in fatigue and physical and social functioning following transplant.

Dedicated financial hardship screening adds value to routine distress screening among gynecologic cancer patients

ObjectivesTo evaluate existing distress screening to identify patients with financial hardship (FH) compared to dedicated FH screening and assess patient attitudes toward FH screening. MethodsWe screened gynecologic cancer patients starting a new line of therapy. Existing screening included: (1) Moderate/severe distress defined as Distress Thermometer score ≥ 4, (2) practical concerns identified from Problem Checklist, and (3) a single question assessing trouble paying for medications. FH screening included: (1) Comprehensive Score for Financial Toxicity (COST) tool and (2) 10-item Financial Needs Checklist to guide referrals. FH was defined as COST score < 26. We calculated sensitivity (patients with moderate/severe distress + FH over total patients with FH) and specificity (patients with no/mild distress + no FH over total patients with no FH) to assess the extent distress screening could capture FH. Surveys and exit interviews assessed patient perspectives toward screening. ResultsOf 364 patients screened for distress, average age was 62 years, 25% were Black, 45% were Medicare beneficiaries, 32% had moderate/severe distress, 15% reported ≥1 practical concern, and 0 reported trouble paying for medications. Most (n = 357, 98%) patients also completed FH screening: of them, 24% screened positive for FH, 32% reported ≥1 financial need. Distress screening had 57% sensitivity and 77% specificity for FH. Based on 79 surveys and 43 exit interviews, FH screening was acceptable with feedback to improve the timing and setting of screening. ConclusionsDedicated FH screening was feasible and acceptable, but sensitivity was low. Importantly, 40% of women with FH would not have been identified with distress screening alone.

Utility and Implementation of the Distress Thermometer for Cancer Patients: A Cross-Sectional Study From Saudi Arabia

Utility and Implementation of the Distress Thermometer for Cancer Patients: A Cross-Sectional Study From Saudi Arabia

Development and Testing of the Aftercare Problem List, a Burn Aftercare Screening Instrument

A growing interest in person-centered care from a biopsychosocial perspective has led to increased attention to structural screening. The aim of this study was to develop an easy-to-comprehend screening instrument using single items to identify a broad range of health-related problems in adult burn survivors. This study builds on earlier work regarding content generation. Focus groups and expert meetings with healthcare providers informed content refinement, resulting in the Aftercare Problem List (APL). The instrument consists of 43 items divided into nine health domains: scars, daily life functioning, scars treatment, body perceptions, stigmatization, intimacy, mental health, relationships, financial concerns, and a positive coping domain. The APL also includes a Distress Thermometer and a question inquiring about preference to discuss the results with a healthcare provider. Subsequently, the APL was completed by 102 outpatients. To test face validity, a linear regression analysis showed that problems in three health domains, i.e., scars, mental health, and body perceptions, were significantly related to higher distress. Qualitative results revealed that a minority found the items difficult which led to further adjustment of the wording and the addition of illustrations. In summation, this study subscribes to the validity of using single items to screen for burn-related problems.

Psychometric validation of the 15-item Patient Health Questionnaire – Anxiety and Depression Scale (PHQ-ADS) to assess psychological distress in breast cancer survivors

ObjectivePsychological distress persists amongst breast cancer survivors, so reliable assessment of symptoms is essential. The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) is a composite measure of depression and anxiety and has been used to measure distress. This study aimed to evaluate the psychometric properties of the PHQ-ADS within breast cancer survivors. MethodBreast cancer survivors (N = 280) were recruited online and followed up at 12-months. Depression (PHQ-8) and anxiety (GAD-7) items formed the composite PHQ-ADS score. Additional measures included: distress thermometer (convergent validity), fear of cancer recurrence and COVID distress (discriminant validity), and self-compassion (predictive validity). Confirmatory factor analysis (CFA) using weighted least squares mean and variance adjusted estimation was undertaken. ResultsOne, two, and bifactor models underlying the PHQ-ADS were evaluated. The bifactor model had the most appropriate model fit overall. Omega hierarchical for the general distress factor was 0.914, accounting for 82% of explained variance. This suggests the PHQ-ADS is sufficiently unidimensional to warrant use of a total composite score. The PHQ-ADS demonstrated strong convergent and moderate discriminant validity. Self-compassion was an independent predictor of distress at 12-months. ConclusionsThe PHQ-ADS is a valid measure for psychological distress in breast cancer survivors prescribed hormone therapy.

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.

Exploring Factors Influencing Cancer Patients' Understanding of Diagnosis, Prognosis, and Emotional Well-being under Palliative Care: A Cross-sectional Investigation

Introduction: The demographic characteristics of cancer patients correlate with their awareness of diagnosis, prognosis, and the psychological distress associated with their condition. Objectives: The purpose of this study was to evaluate patients' knowledge of psychological distress, diagnosis, and prognosis who were presenting to the palliative medicine department of a tertiary hospital in Bangladesh. Methodology: This cross‐sectional study was conducted among 377 patients living with cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from November 2021 and March 2022. Information on the clinical and sociodemographic aspects was gathered through a structured questionnaire and in-person interview, and the degree of distress was measured using a distress thermometer. After information was gathered, descriptive statistics were used to analyze it. Result: Approximately 16.2% of patients were unaware of their diagnosis, with two-thirds (68%) lacking awareness of prognosis. Over half (54.1%) reported significant distress. Gender, education, employment status, and head-and-neck cancer diagnosis were linked to diagnosis awareness, while educational level predicted prognosis awareness. Younger age, head-and-neck or hematological cancer diagnosis and lack of awareness regarding diagnosis and prognosis were associated with distress. Conclusions: Higher education and socioeconomic status correlate with patients' awareness of diagnosis and prognosis. However, distress remains higher among those unaware of prognosis.

Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera: the "RAMP" Italian multicenter prospective study.

Ruxolitinib is beneficial in patients with myelofibrosis (MF) and polycythemia vera (PV). Information on ruxolitinib adherence is scant. The Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera (RAMP) prospective multicenter study (NCT06078319) included 189 ruxolitinib-treated patients. Patients completed the Adherence to Refills and Medications Scale (ARMS) and Distress Thermometer and Problem List (DTPL) at the earliest convenience, after registration in the study, and at later timepoints. At week-0, low adherence (ARMS > 14) and high distress (DT ≥ 4) were declared by 49.7% and 40.2% of patients, respectively. The main reason for low adherence was difficult ruxolitinib supply (49%), intentional (4.3%) and unintentional (46.7%) non-take. In multivariable regression analysis, low adherence was associated to male sex (p = 0.001), high distress (p < 0.001), and treatment duration ≥ 1year (p = 0.03). Over time, rates of low adherence and high distress remained stable, but unintentional non-take decreased from 47.9% to 26.0% at week-48. MF patients with stable high adherence/low distress were more likely to obtain/maintain the spleen response at week-24. Low adherence to ruxolitinib represents an unmet clinical need that require a multifaceted approach, based on reason behind it (patients characteristics and treatment duration). Its recognition may help distinguishing patients who are truly refractory and those in need of therapy optimization.

The Hemodialysis Distress Thermometer for Caregivers (HD-DT-C): development and testing of the psychometric properties of a new tool for screening psychological distress among family caregivers of adults on hemodialysis.

To develop and test the measurement properties of the HD-DT-C, a new tool designed to facilitate the screening of psychological distress and its sources in family caregivers of adults on hemodialysis. The present investigation was carried out in three phases: Phase 1 focused on the process of developing and exploring the content validity and clinical utility of the HD-DT-C using a mixed-methods approach and feedback panels; Phase 2, where the psychometric properties of this new tool were tested in a cross-sectional study (n = 106 caregivers); and Phase 3, where the European Portuguese version of the HD-DT-C was translated and culturally adapted into American English using a forward-backward translation procedure, followed by an expert panel review. Findings suggested that the HD-DT-C was perceived by feedback panels as practical, appropriate, and useful for increasing dialysis provider/family caregiver communication in nephrology centers. The European Portuguese version of the HD-DT-C showed good test-retest reliability (ICC = 0.991 for the barometer and κ ≥ 0.80 in 77% of the checklist items), high diagnostic accuracy (AUC = 0.956), and strong convergent validity (all r ≥ 0.50) with reference measures that assess quality of life, caregiver burden, and symptoms of anxiety and depression. Cutoff scores with good clinical utility (CUI +  ≥ 0.70) were recommended for screening distress in research (≥ 6) and clinical practice (≥ 5). The HD-DT-C is a brief, reliable, valid, and acceptable measure for identifying self-reported psychological distress and its sources among people caring for a family member or friend on hemodialysis. Future research is needed to explore the measurement properties of the American English version of this new tool.

Risk Factors Associated With Distress Among Postoperative Patients in an Academic Gynecologic Oncology Practice.

Distress among gynecologic oncology patients correlates with poor clinical outcomes and decreased quality of life. The purpose of this study was to determine risk factors for elevated NCCN Distress Thermometer (DT) results among postoperative gynecologic oncology patients. We performed a retrospective chart review of all postoperative visits over a 5-year period. NCCN DT results were analyzed as both discretized values (DT ≤3 = low distress; DT 4-8 = moderate distress; DT ≥9 = high distress) and continuous variables. Patients with a DT score ≥4 were referred to social work. Univariate and multivariate regression analyses were performed to compare NCCN DT results with clinical and sociodemographic variables. Statistical significance was P<.05. In total, 1,795 NCCN DT results were included, with uterine (37.72%) being the most common disease site. Benign pathology was known prior to completion of the NCCN DT in 13.15% of patients. Most patients (71.75%) endorsed low levels of distress. Moderate/High levels of distress were reported by 28.25% of patients. Increasing levels of distress were significantly associated with younger age (P=.006), history of depression (P≤.001), status as a current smoker (P=.028), and history of asthma (P=.041). Knowledge of benign pathology was associated with low levels of distress (P=.002). Procedure type and disease site were not associated with distress. More than one-fourth of postoperative patients in a gynecologic oncology practice reported moderate or high distress. Distress was highest among those with malignancy regardless of disease site or surgical intervention. Benign pathology correlated with decreased distress. Identified associations with distress provide opportunities for prevention, early intervention, and tailored counseling.

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

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). 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). 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. 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.

Familial and Social Implications of Breast and Gynaecological Cancer in Kerala, India

BackgroundDue to the paucity of reliable data to determine the components of family-based comprehensive care for cancer in India, we explored the familial implications of gynaecological and breast cancer diagnosis and treatment through a mixed-method study. MethodsThe mixed method study included 130 women aged above 18 with a confirmed diagnosis of gynaecological or breast cancer recruited from three selected tertiary hospitals in Kerala, India. Information on quality of life (36-Item Short Form Survey (SF-36)), psychological distress (distress thermometer), and the familial, interpersonal, social, and community impacts of cancer (semi-structured interview guide) were elicited. Linear regression was used to identify the factors associated with distress and the factors were explored further using thematic analysis. ResultsPatients included in the study (n = 130; mean age 57.5 years) had moderate or mild (66.9%) to severe (25.4%) distress. Concerns about work (93%), difficulty in; home care and housing (82%), care for dependents (65%), unempathetic family (87.6%), isolation (70%), and body image (65%) were major reasons for their distress. Physiological, social, and family-related stressors among the respondents included challenges in physical functioning, intense physical symptoms like fatigue, loss of appetite and sleep, role restrictions, alterations in family responsibilities, functional dependency, inadequate family support, challenges in social and interpersonal interactions, and an unsupportive work environment. ConclusionCancer is a health crisis that involves psychological, social, and economic distress, compelling professionals to design multifaceted individualized care packages rather than only concentrating on medical management to alleviate their distress.

Mental health outcomes and their influencing factors on patients with COVID-19 in the Fangcang shelter hospital in China.

Coronavirus disease 2019 (COVID-19) affects physical and mental health of patients. This study aimed to investigate the psychological distress, level of hope, and the role of families of patients with COVID-19 in the Fangcang shelter hospital (FSH) and explore potential influencing factors. We conducted an online observational cross-sectional study on 397 patients with mild to moderate COVID-19 from two FSH in Shanghai, China from 12 April to 16 May 2022. The questionnaire included demographic information, distress thermometer (DT), family adaptation, partnership, growth, affection, resolve (APGAR) index, and the Herth hope index (HHI). The patients reported symptoms of severe psychological distress (n = 109, 27.46%) and low levels of family care (n = 152, 38.29%). More than half of the patients (n = 244, 61.46%) exhibited high levels of hope, and around one-third of the patients (n = 151, 38.04%) reported moderate levels of hope. The study noted a significant negative correlation between the scores for psychological distress and APGAR and a significant positive correlation between the scores for APGAR and HHI (p < 0.05). The FSH living experience, diet, and symptoms of COVID-19 were closely associated with psychological distress among patients (p < 0.05). Patients with COVID-19 living in the FSH reported high levels of symptoms of psychological distress and low levels of family care, but relatively high levels of hope. Health care workers should improve the living and eating conditions in the FSH, strengthen family support, and alleviate the COVID-19 related symptoms of patients.

EVALUATION OF EMOTIONAL DISTRESS IN A COHORT OF NEWLY DIAGNOSED CANCER PATIENTS: A STUDY OF 67 INDIVIDUAS

Purpose: To evaluate distress in newly diagnosed cancer patients. Subjects and Methods: Cross-sectional prospective study of 67 newly diagnosed patients at the Department of Pain management and Palliative Care, 108 Military Central Hospital, from August to October 2023. The patient's level of distress was assessed by the Distress Thermometer - DT and the Problem List (PL) of NCCN February 2022, Vietnamese version. Results: The average distress score among newly diagnosed cancer patients was 4.42 ± 2.237, with 3% reporting no distress, 44.8% experiencing mild distress, and 52.2% reporting moderate to severe distress (≥ 4 points). Common sources of distress among the participants included physical discomfort (94.0%), with 73.1% reporting sleep problems and 71.6% experiencing fatigue. Emotional challenges were prevalent as well (91.0%), with 49.3% reporting feelings of sadness and 47.8% experiencing anxiety. Additionally, concerns regarding self-care (53.7%) and financial worries (43.3%) were notable contributors to distress, accounting for 76.1% of the participants' concerns overall. The rate of moderate and severe distress in newly diagnosed cancer patients were statistically significantly related to age (more prevalent in patients  under 60), gender (higher in females) education level (more in those with secondary school education or less), income (higher in those with below-average incomes), health insurance benefits (higher in patients with less comprehensive coverage).

Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease.

Psychological co-morbidities are common in chronic obstructive pulmonary disease (COPD) but remain overlooked. Psychosocial interventions are deemed to promote mental health and optimize management. This study aimed to determine the role of detailed psychological evaluation and treatment in the comprehensive management of COPD. COPD patients after screening with the general health questionnaire-12 (GHQ-12) for psychological co-morbidity were divided into three groups (26 patients each): i) group A [GHQ-12 score<3, received pulmonary rehabilitation (PR) and standard medical management]; ii and iii) group B and C (GHQ-12 score>3, in addition, received management by a psychiatrist and counseling by a pulmonologist, respectively). At baseline and 8 weeks of follow-up, all participants were evaluated for respiratory [forced expiratory volume in the first second (FEV1), six-minute walk distance (6-MWD), St. George's respiratory questionnaire (SGRQ), modified medical research council (mMRC) dyspnea scale], and psychological [GHQ-12, patient distress thermometer (PDT), coping strategy checklist (CSCL), World Health Organization-quality of life-brief (WHOQOL-Bref-26), and depression anxiety stress scales (DASS)] parameters. Psychological distress (GHQ-12>3) decreased significantly at follow-up, with 11.5% and 53.8% of patients having psychological distress in groups B and C, respectively, versus baseline (p<0.001). mMRC score, SGRQ score, FEV1 and 6-MWD significantly improved in all three groups. Improvement in mMRC and SGRQ was maximal in group B when compared with the other groups. PDT, CSCL, and WHO-QOL-Bref-26 scores improved significantly at follow-up in all three groups, with maximum improvement in group B, followed by group C, and then group A. The DASS score also improved maximally in group B. Patients should be screened for psychological co-morbidities using simple screening tools. PR plays an important role in improving the psychology of COPD patients. However, results are better with directed psycho-educative sessions by non-experts and best with definitive treatment by psychiatrists.

Study on the cut-off point and the influencing factors of distress in newly diagnosed breast cancer patients.

Our aim is to investigate the cut-off point of distress and the influencing factors associated with distress in patients with newly diagnosed breast cancer. A cross-sectional survey of distress was conducted in 167 patients with newly diagnosed breast cancer admitted to the Department of General Surgery of a tertiary care hospital from July 2020 to March 2022. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) questionnaire within 3 days of admission. The HADS ≥15 was used as the gold standard, and the cut-off point of the DT measure was analyzed using the Receiver Operating Characteristic (ROC) curve. The cut-off point obtained by ROC curve analysis was used to analyze the influencing factors of distress in breast cancer patients by univariate and multivariate regression analysis. A total of 167 patients completed the survey, with an average HADS score of 8.43 ± 5.84 and a total HADS score of ≥15 in 37 (22.16%) patients, the mean DT score was 2.96 ± 1.85. ROC curve analysis showed an area under the curve of 0.885, with a maximum Jorden index (0.723) at a DT score of 4, the sensitivity was 100.0% and specificity was 72.3%. There were 73 (43.71%) patients with DT score ≥ 4. Regression analysis showed that insurance/financial problems, dealing with partner problems, tension, bathing/dressing problems, pain, and sleep problems were independent risk factors for l distress in newly diagnosed breast cancer patients. A DT score 4 is the cut-off point for distress in patients with newly diagnosed breast cancer. In clinical practice, target intervention should be carried out according to the risk factors of distress of patients.