Purpose:
Using Brief Symptom Inventory (BSI), a landmark study, with a sample size of 4496, reveals that 30 to 43% of newly diagnosed cancer patients have significant levels of psychological distress (1). The Distress Thermometer (DT) has been recommended by the National Comprehensive Cancer Network for screening psychosocial distress (2). At KF-SYSCC, the DT has been used to screen distress in all new patients since 2007. The goal of this study was to assess the prevalence of psychosocial distress among different cancer types and its probable risk factors.

Method:
All newly diagnosed cancer patients, who fit the following criteria and received treatment at KF-SYSCC between 2007 and 2010, were included in this study:
1. Major cancer type, of which the total number of patients were more than 100 from this time period;
2. Age 18 or older; and
3. DT screening done within 90 days after the diagnoses.
The optimal cutoff was set at DT>=4 (3). Rates of distress were analyzed by cancer type, and by probable related factors such as gender, age, disease stage and pain score.

Results:
Five thousand three hundred and thirty five (5335) newly diagnosed cancer patients of 12 major cancer types, seen between Jan. 1, 2007 and Dec. 31, 2010, were included in this study. Over all, 1771 (33.20%) were significantly distressed. The prevalence rates varied from 22 to 36% among the cancer types. Esophageal, breast, nasopharyngeal, gastric, thyroid and lung cancers had the highest rate, while prostate and bladder cancer had the lowest. The differences were very moderate. Younger age, female gender and higher pain score, but not the stage of disease, were found correlated with higher rates of distress.

Conclusion:
Between 22 and 36% of newly diagnosed cancer patients are significantly distressed. The rate of significant distress is positively correlated with younger age, female gender, higher pain score, but not the stage of disease. There are moderate differences in the prevalence rates by cancer type. The lack of correlation between disease stage and rate of distress may be partially related to the cultural factors in truth telling and family relationship (4, 5).

Clinical implications:
A third of newly diagnosed cancer patients are distressed and need to be referred for further assessment and intervention. The family members should be closely involved in this process in our patient population.

Research implications:
Further studies are needed to evaluate the outcome of the routine screening of psychosocial distress, the follow-up assessment and intervention.

Acknowledgement: none

References:

1. Zabora J, et al. The prevalence of psychological distress by cancer site. Psycho-Oncology 10: 19-28 (2001).
2. National Comprehensive Cancer Network, Inc. NCCN Practice Guidelines in Oncology – V.I. 2003, Distress Management, 2003.
3. Wang GL, et al. The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan. Psych-Oncology 20: 639-646 (2011).
4. Tang ST, et al. Cancer diagnosis and prognosis in Taiwan: patient preferences versus experiences. Psycho-Oncology 13:1-13 (2004).
5. Juan Li, et al. Whether, when, and who to disclose bad news to patients with cancer: a survey in 150 pairs of hospitalized patients with cancer and family members in China. Psycho-Oncology (wileyonlinelibrary.com). DOI:10.1002/pon.1979 (2011).