Using the distress thermometer to screen newly diagnosed patients with advanced cancer for depression — ASN Events
  1. Schedule
  2. IPOS - Screening for distress: A practical guide to what really works
  3. Using the distress thermometer to screen newly diagnosed patients with advanced cancer for depression

Using the distress thermometer to screen newly diagnosed patients with advanced cancer for depression (#232)

Mark Lazenby 1 , Jane Dixon 1 , Mei Bai 1 , Elizabeth Ercolano 1 , Ruth McCorkle 1
  1. Yale University, New Haven, CT, United States

Background: Distress screening guidelines call for rapid screening for emotional distress at the time of cancer diagnosis. In this study of baseline data, we asked whether the DT can be used as a screening instrument to screen in possible cases of depression and whether the Emotional Problem List can be an aid in such rapid screening. 

Methods: Using cross-sectional data collected from patients at a U.S.-based comprehensive cancer center within 100 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.

Results: 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).

Conclusion: 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.

Implications for Practice: The DT ≥2 and EPL items may best be used to rule in cases of depression than to rule out, and thus, its use should be as a rapid screening instrument to identify patients in need of further evaluation as part of a comprehensive distress screening process. 

Implications for Research: Further research in needed on using the DT in a two-stage screening process, in which possible cases of depression are screened in using the DT and further evaluation is used to identify actual cases of emotional distress.