Screening for distress in cancer patients: Is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study

UCL Hospitals Gynaecological Oncology Centre, Elizabeth Garrett Anderson Hospital, London, UK.
Psycho-Oncology (Impact Factor: 2.44). 06/2008; 17(6):538-47. DOI: 10.1002/pon.1273
Source: PubMed


A prospective validation study was conducted in 171 consenting patients from oncology and palliative care outpatient clinics to validate the Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire-12 (GHQ-12) and Brief Symptom Inventory-18 (BSI-18) at baseline, four weeks and eight weeks.
Receiver Operating Characteristic analysis was used to examine the sensitivity and specificity of the DT scores against the clinically significant cut-off scores of the criterion measures reporting 95% confidence intervals. Standardised response means were used to compare DT scores with criterion measures over time.
For a cut-off of 4 vs 5, sensitivity against HADS was 79%, specificity 81%; against GHQ-12, sensitivity was 63%, specificity 83%; and against BSI-18, sensitivity was 88%, specificity 74%. At both four and eight weeks, DT scores tended to change significantly in the same direction as the criterion measures. Ninety-five percent of patients found completing the DT acceptable.
The DT is valid and acceptable for use as a rapid screening instrument for patients in the UK with cancer. Our results indicate that it can be used to monitor change in psychological distress over time, but further work is needed to confirm this. Copyright

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    • "The scale ranges from 0 (no distress) to 10 (extreme distress). Scores of 5 and 6 indicate moderate distress, while scores of 7 or greater indicate high distress [16]. "
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    ABSTRACT: Objective: To determine High Grade Glioma (HGG) patients' levels of distress and QOL during combined chemoradiotherapy, explore predictors of distress and QOL and prioritize patients' supportive care needs. Methods: Patients diagnosed with HGG who were referred for combined chemoradiotherapy were recruited. Participants completed demographics and questionnaires assessing distress, function, and supportive care needs. Descriptive statistics, correlation coefficients, t-tests and linear and logistic regression analyses were performed. Results: 116 participants completed the questionnaire. Participants scored lower for QOL in physical, functional and emotional domains than the general Australian population. Poor physical function, lower education levels, loss of employment and financial impact associated with diagnosis were consistently linked with multiple domains of distress, poor QOL and high unmet needs. Having a carer who was their partner predicted lower emotional well-being. Conclusion: Patients with HGG experience a poor QOL, increased levels of distress and high unmet needs when commencing chemoradiotherapy. Patients who experience a financial impact and those with lower education levels may report higher levels of distress and increased unmet needs. Practice implications: Poor function, lower education and limited financial resources may help identify those who require additional screening and may benefit from additional information and psychological support at this time.
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    • "Participants were asked to indicate how much distress they had experienced in the past week on a scale of 0 ('no distress') to 10 ('extreme distress'). The DT has been shown to be a psychometrically sound measure of global psychological distress with cancer patients and carers, with a score of four or above signifying clinically significant distress (Ransom et al. 2006; Gessler et al. 2008; Zwahlen et al. 2008). Levels of anxiety and depression were measured with the self-administered Hospital Anxiety and Depression Scale (HADS). "
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    • "It has been recommended for use in identifying psychological distress in a clinical setting [25]. The Distress Thermometer (DT)[26] is a reliable and valid single item measure of distress in cancer populations, which appears responsive to change [27]. "
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