Abstract
Purpose
International organizations such as National Comprehensive Cancer Network and NICE recommend implementation of routine screening programs for detecting and managing psychosocial distress among cancer patients. The selection of an adequate screening tool is crucial to the effectiveness of these programs. The present study examines the emotional symptomatology captured by the Distress Thermometer (DT) and its accuracy and validity as a screening tool in cancer. It also explores the possible discrepancy between patient distress and the use of psycho-oncology resources.
Methods
A heterogeneous sample of 962 adult cancer patients completed the DT, the Problem List (PL), the Brief Symptom Inventory-18 (BSI-18), and the Psychosocial Questionnaire.
Results
The DT was significantly correlated with BSI-18 symptoms and the emotional problems listed on the PL. Receiver Operating Characteristic analysis showed good diagnostic accuracy for the DT (area under the curve = .82, 95 %CI [.79–.85]). For a selected DT cutoff of 5, standard measures (sensitivity = 90 %, specificity = 64 %, predictive positive value = 35 %, and negative predictive value = 97 %) and Clinical Utility Indexes (utility index negative = .62 and utility index positive = .32) indicated that the DT was adequate for “screening” while it was limited for “case finding.” Finally, 81.30 % of patients with clinical distress had not sought or were not receiving professional psychosocial support at the time of the study.
Conclusion
The DT is appropriate for use as a rapid screening instrument for cancer patients in a Spanish population because it assesses a broad concept of distress including both anxiety and depression symptoms. The diagnostic accuracy of the DT could be improved with minor proposed modifications to the DT and the inclusion of nonemotional ultrashort measures.
Similar content being viewed by others
References
NCCN (2013) NCCN Clinical Practice Guidelines in Oncology: Distress Management V.5.2012 http://www.nccn.org/professionals/phisician_gls/PDF/distress.pdf. Accessed 10 Jan 2012
Watson M, Jacobsen P (2012) [Editorial for special issue on stress and cancer]. Stress Health 28:353–354
Carlson L, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304
Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychosocial distress by cancer site. Psycho-Oncology 10:19–28
Mitchell A, Chan M, Bhatti H, Halton M, Grassi L, Johansen C et al (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet 12:160–174
Kadan-Lottick NS, Vanderwerker LC, Block SD, Zhang B, Prigerson HG (2005) Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study. Cancer 104:2872–2881
Sharpe M, Strong V, Allen K, Rush R, Postma K, Tulloh A et al (2004) Major depression in outpatients attending a regional cancer center: screening and unmet treatment needs. Br J Cancer 90:314–320
Bultz B, Holland J (2006) Emotional distress in patients with cancer: the sixth vital sign. Commun Oncol 3:311–314
Carlson L, Waller A, Mitchell AJ (2012) Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol 10:1160–1177
Mitchell AJ (2010) Short screening tools for cancer-related distress: a review and diagnostic validity meta-analysis. J Natl Compr Canc Netw 8:487–494
Vodermaier A, Linden W, Siu C (2009) Screening for emotional distress in cancer patients: a systematic review of assessment instruments. J Natl Cancer Inst 101:1464–1488
Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC (1998) Rapid screening for psychological distress in men with prostate carcinoma: a pilot study. Cancer 82:1904–1908
Mitchell AJ (2007) Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol 25:4670–4681
Hoffman B, Zevon MA, D’Arrigo MC, Cecchini TB (2004) Screening for distress in cancer patients: the NCCN rapid-screening measure. Psycho-Oncology 13:792–799
Snowden A, White CA, Christie Z, Murray E, McGowan C, Scott R (2011) The clinical utility of the Distress Thermometer: a review. Br J Nursing 20:220–227
Akizuki N, Akechi T, Nakanishi T, Yoshikawa E, Okamura M, Nakano T et al (2003) Development of a brief screening interview for adjustment disorders and major depression in patients with cancer. Cancer 97:2605–2613
Ransom S, Jacobsen PB, Booth-Jones M (2006) Validation of the Distress Thermometer with bone marrow transplant patients. Psycho-Oncology 15:604–612
Mitchell AJ (2010) Clinical Utility Index—a new method to calculate the clinical value of diagnostic & screening tests: proof of concept study. Psycho-Oncology 19(2):686
Akizuki N, Yamawaki S, Akechi T, Nakano T, Uchitomi Y (2005) Development of an Impact Thermometer for use in combination with the Distress Thermometer as a brief screening tool for adjustment disorders and/or major depression in cancer patients. J Pain Symptom Manage 29:91–99
Bauwens S, Baillon C, Distelmans W, Theuns P (2009) The ‘Distress Barometer’: validation of method of combining the Distress Thermometer with a rated complaint scale. Psycho-Oncology 18:534–542
McLaren D, Woolley C (2011) Validation of the Distress Thermometer, Impact Thermometer and combinations of these in screening for distress. Psycho-Oncology 20:609–614
Gil F, Grassi L, Travado L, Tomamichel M, González JM (2005) Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients. Support Care Cancer 13:600–606
Mitchell AJ, Baker-Glenn EA, Granger L, Symonds P (2010) Can the Distress Thermometer be improved by additional mood domains? Part I. Initial validation of the Emotion Thermometers tool. Psycho-Oncology 19:125–133
Mitchell AJ, Baker-Glenn EA, Park B, Granger L, Symonds P (2010) Can the Distress Thermometer be improved by additional mood domains? Part II. What is the optimal combination of Emotion Thermometers? Psycho-Oncology 19:134–140
Derogatis LR (2000) The Brief Symptom Inventory 18 (BSI-18): administration, scoring and procedures manual. National Computer Systems, Minneapolis
Galdón MJ, Durá E, Andreu Y, Ferrando M, Murgui S, Pérez S et al (2008) Psychometric properties of the Brief Symptoms Inventory 18 (BSI-18) in a Spanish breast cancer sample. J Psychosom Res 65:533–539
Bevans M, Wehrlen L, Prachenko O, Soeken K, Zabora J, Wallen G (2011) Distress screening in allogeneic hematopoietic stem cell (HSCT) caregivers and patients. Psycho-Oncology 20:615–622
Merport A, Bober SL, Grose A, Recklitis C (2012) Can the distress thermometer (DT) identify significant psychological distress in long-term cancer survivors? a comparison with the Brief Symptom Inventory-18 (BSI-18). Support Care Cancer 20:195–198
Domenech JM (2004) Fundamentos de Diseño y Estadística, UD 3: Fundamentos de la teoría de la probabilidad. Pruebas diagnósticas, Signo, Barcelona
Franco M, Vivo JM (2007) Análisis de Curvas ROC. Principios básicos y aplicaciones, La Muralla, Madrid
Watson D (2005) Positive affectivity: the disposition to experience pleasurable emotional states. In: Snyder CR, Lopez SJ (eds) Handbook of positive psychology. Oxford University Press, New York, pp 106–118
Duckworth A, Steen T, Seligman M (2005) Positive psychology in clinical practice. Annu Rev Clin Psychol 1:629–651
Gessler S, Low J, Daniells E, Williams R, Brough V, Tookman A et al (2008) 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. Psycho-Oncology 17:538–547
Mitchell AJ (2010) Screening procedures for psychosocial distress. In: Holland J, Breitbart WS, Jacobsen PB, Lederberg M, Loscalzo MJ, McCorkle R (eds) Psycho-oncology, 2nd edn. Oxford University Press, New York, pp 389–396
Zebrack B, Burg MA, Vaitones V (2012) Distress screening: an opportunity for enhancing quality cancer care and promoting the oncology social work profession. J Psychosoc Oncol 30:615–624
Mitchell AJ, Kaar S, Coggan C, Herdman J (2008) Acceptability of common screening methods used to detect distress and related mood disorders—preferences of cancer specialists and non-specialists. Psycho-Oncology 17:226–236
Acknowledgments
The authors thank all the study participants and staff at the FIVO for their cooperation. This research was funded by the Ministry of Economy and Competitiveness, Government of Spain (REF: PSI2010-15355).
Conflict of interest
The authors have declared that no conflict of interest exists.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Martínez, P., Galdón, M.J., Andreu, Y. et al. The Distress Thermometer in Spanish cancer patients: convergent validity and diagnostic accuracy. Support Care Cancer 21, 3095–3102 (2013). https://doi.org/10.1007/s00520-013-1883-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-013-1883-7