Skip to main content
Log in

Measurement of psychological distress in patients with intracranial tumours: the NCCN distress thermometer

  • Clinical Study – Patient Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Identification of patients suffering from elevated psychosocial distress, the sources of the distress, and the necessary treatment of the distress can be rather difficult within the neurosurgical setting (e.g., lack of time, cognitive or aphasic disorders of the patients). The distress thermometer (DT) is a single-item rapid distress screening tool by use of which these difficulties can be minimized. The objective of this study was to determine the optimum DT cut-off score that would identify significant distress in patients with intracranial tumours thus validating its use in the neurosurgical setting. In all, 150 patients were tested either during in-patient stay or during a follow-up examination before and after the neurosurgical removal of a primary intracranial neoplasm. Patients were administered the DT with the hospital anxiety and depression scale (HADS), the gold standard against which the DT was compared. The area under the receiver operating characteristics curve (ROC) was ≥0.82. Thus, the ability of the DT to correctly identify patients as significantly distressed was excellent. The DT ranges from 0 to 10. Its optimum cut-off score for identifying distressed patients was at or above 6 (sensitivity ≥ 88%; specificity ≥ 53%). The DT is a valid and practicable screening instrument for assessment of levels and sources of distress in patients with intracranial tumours in the neurosurgical setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Litofsky NS, Farace E, Anderson F, Meyers CA, Huang W, Le R (2004) Depression in patients with high-grade glioma: results of the glioma outcome project. Neurosurgery 54:358–366

    Article  PubMed  Google Scholar 

  2. Mainio A, Hakko H, Timonen M, Niemelä A, Koivukangas J, Räsänen P (2005) Depression in relation to survival among neurosurgical patients with primary brain tumor: a 5-year follow-up study. Neurosurgery 56:1234–1242

    Article  PubMed  Google Scholar 

  3. Mainio A, Tuunanen S, Hakko H, Niemelä A, Koivukangas J, Räsänen P (2006) Decreased quality of life and predictors for shorter survival among patients with low-grade gliomas: a follow-up from 1990–2003. Eur Arch Psychiatry Clin Neurosci 256:516–521

    Article  PubMed  Google Scholar 

  4. McCarter H, Furlong W, Whitton AC, Feeny D, DePauw S, Willan AR et al (2006) Health status measurements at diagnosis at predictors of survival among adults with brain tumours. J Clin Oncol 24:3636–3643

    Article  PubMed  Google Scholar 

  5. Colleoni M, Mandala M, Peruzzotti G, Robertson C, Bredart A, Goldhirsch A (2000) Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet 356:1326–1327

    Article  PubMed  CAS  Google Scholar 

  6. Faller H, Bulzebruck H, Drings P, Lang H (1999) Coping, distress, and survival among patients with lung cancer. Arch Gen Psychiatry 56:756–762

    Article  PubMed  CAS  Google Scholar 

  7. Parker PA, Baile WF, de Moor C, Cohen L (2003) Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology 12:183–193

    Article  PubMed  Google Scholar 

  8. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM (1999) Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet 354:1331–1336

    Article  PubMed  CAS  Google Scholar 

  9. Fallowfield L, Ratcliffe D, Jenkins V, Saul J (2001) Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 84:1011–1015

    Article  PubMed  CAS  Google Scholar 

  10. Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S (1998) Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol 16:1594–1600

    PubMed  CAS  Google Scholar 

  11. Cochinov HM (2001) Depression in cancer patients. Lancet Oncol 2:499–505

    Article  Google Scholar 

  12. Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E (2007) Quality of life among patients with a brain tumour and their carers. J Psychosom Res 63:617–623

    Article  PubMed  Google Scholar 

  13. Zabora JR, BrintzenhofeSzoc KM, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28

    Article  PubMed  CAS  Google Scholar 

  14. Arnold SD, Forman LM, Brigidi BD, Carter KE, Schweitzer HA, Qiunn HE et al (2008) Evaluation and characterization of generalized anxiety and depression with primary brain tumors. J Neurooncol 10:171–181

    Google Scholar 

  15. Keir ST, Guill AB, Carter KE, Friedman HS (2006) Stress and intervention preferences of patients with brain tumors. Support Care Cancer 14:1213–1219

    Article  PubMed  Google Scholar 

  16. Litofsky NS, Resnick AG (2009) The relationships between depression and brain tumours—review. J Neurooncol 94:153–161

    Article  PubMed  Google Scholar 

  17. Brown PD, Ballman KV, Rummans TA, Maurer MJ, Sloan JA, Boeve BF et al (2006) Prospective study of Quality of life in adults with newly diagnosed high-grade gliomas. J Neurooncol 76:283–291

    Article  PubMed  Google Scholar 

  18. Gustafsson M, Edvardsson T, Ahlström G (2006) The relationship between function, quality of life and coping in patients with low-grade gliomas. Support Care Cancer 14:1205–1212

    Article  PubMed  Google Scholar 

  19. Kvale EA, Murthy R, Taylor R, Lee JY, Nabors LB (2009) Distress and quality of life in primary high-grade brain tumor patients. Support Care Cancer 17:793–799

    Article  PubMed  Google Scholar 

  20. Pelletier G, Verhoef MJ, Khatri N, Hagen N (2002) Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. J Neurooncol 57:41–49

    Article  PubMed  Google Scholar 

  21. Janda M, Eakin E, Bailey L, Walker D, Troy K (2006) Supportive care needs of people with brain rumours and their carers. Support Care Cancer 14:1094–1103

    Article  PubMed  Google Scholar 

  22. Janda M, Steginga S, Dunn J, Langbecker D, Walker D, Eakin E (2008) Unmet supportive care needs and interest in services among patients with a brain tumour and their carers. Patient Educ Couns 71:251–258

    Article  PubMed  Google Scholar 

  23. Adelbratt S, Strang P (2000) Death anxiety in brain tumour patients and their spouses. Palliat Med 14:499–507

    Article  PubMed  CAS  Google Scholar 

  24. Davies E, Higginson IJ (2003) Communication, information and support for adults with malignant cerebral glioma: a systematic literature review. Support Care Cancer 11:21–29

    PubMed  Google Scholar 

  25. Holland JC (2002) History of psycho-oncology: overcoming attitudinal and conceptual barriers. Psychosom Med 64:206–221

    PubMed  Google Scholar 

  26. Taphoorn MJ, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3:159–168

    Article  PubMed  Google Scholar 

  27. NCCN (2003) Distress management clinical practice guidelines. J Natl Compr Care Netw 1:344–374

    Google Scholar 

  28. Mehnert A, Müller D, Lehmann C, Koch U (2006) Die deutsche Version des NCCN Distress-Thermometers—Empirische Prüfung eines Screening-Instruments zur Erfassung psychosozialer Belastungen bei Krebnspatienten. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie. 54:213–223

    Article  Google Scholar 

  29. Lynch J, Goodhart F, Saunders Y, O’Connor SJ (2010) Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient Distress Thermometer. Support Care Cancer. doi:10.1007/s00520-009-0799-8

  30. Ransom S, Jacobsen PB, Booth-Jones M (2006) Validation of the Distress Thermometer with bone marrow transplant patients. Psychooncology 15:604–612

    Article  PubMed  Google Scholar 

  31. Trask PC, Paterson A, Riba M, Brines B, Griffith K, Parker P et al (2002) Assessment of psychological distress in prospective bone marrow transplant patients. Bone Marrow Transplant 29:917–925

    Article  PubMed  CAS  Google Scholar 

  32. Bulli F, Miccinesi G, Maruelli A, Katz M, Paci E (2009) The measure of psychological distress in cancer patients: the use of Distress Thermometer in the Oncological Rehabilitation Center of Florence. Support Care Cancer 17:771–779

    Article  PubMed  Google Scholar 

  33. Keir ST, Calhoun-Eagan RD, Swartz JJ, Saleh OA, Friedman HS (2008) Screening for distress in patients with brain cancer using the NCCN’s rapid screening measure. Psychooncology 17:621–625

    Article  PubMed  Google Scholar 

  34. Huber W, Poeck K, Weninger D, Willmes K (1983) Der Aachener Aphasie Test (AAT). Hogrefe, Göttingen

    Google Scholar 

  35. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-Mental-State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  36. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  37. Herrmann C, Buss U, Snaith RP (1995) HADS-D—Hospital Anxiety and Depression Scale—Deutsche Version: Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Huber, Bern

  38. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale—an updated literature review. J Psychosom Res 52:69–77

    Article  PubMed  Google Scholar 

  39. Herrmann C (1997) International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results. J Psychosom Res 42:17–41

    Article  PubMed  CAS  Google Scholar 

  40. Altman DG (1991) Practical statistics for medical research. Chapman & Hall, Boca Raton

    Google Scholar 

  41. Leplow B, Friege L (1998) Eine Sozialformel zur Schätzung der prämorbiden Intelligenz. Zeitschrift für Klinische Psychologie 27:1–8

    Google Scholar 

  42. Barona A, Reynolds CR, Chastain R (1984) A demographically based index of premorbid intelligence for the WAIS-R. J Consult Clin Psychol 52:885–887

    Article  Google Scholar 

  43. Gil F, Grassi L, Travado L, Tomamichel M, Gonzales JR (2005) Use of distress and depression thermometer to measure psychosocial morbidity among southern European cancer patients. Support Care Cancer 13:600–606

    Article  PubMed  Google Scholar 

  44. 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. Psychooncology 17:226–236

    Google Scholar 

  45. Newell SA, Sanson-Fisher RW, Savolainen NJ (2002) Systematic review of psychological therapies for cancer patients: Overview and recommendations for future research. J Natl Cancer Inst 94:558–584

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Simone Goebel.

Appendix 1: Distress thermometer

Appendix 1: Distress thermometer

figure a

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goebel, S., Mehdorn, H.M. Measurement of psychological distress in patients with intracranial tumours: the NCCN distress thermometer. J Neurooncol 104, 357–364 (2011). https://doi.org/10.1007/s11060-010-0501-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-010-0501-5

Keywords

Navigation