Background. This pilot study assessed the levels of patient emotional distress and impact on clinic throughput time.Methods. From April through August 2012, 149 breast cancer patients at the Penn State Hershey Breast Center were screened with the emotions thermometer (ET), a patient-rated visual 0-10 scale that measures distress, anxiety, depression, anger, burden, and need for help. Also, patients indicated their most pressing cancer-related concerns. Clinic visit time was computed and compared with a control group. Results. Using a previously validated cut point C4 for any thermometer, we found emotional difficulty in the following proportions: distress 22 %, anxiety 28 %, depression 18 %, anger 14 %, burden 16 %, and need for help 10 %; 35 % scored above the cut point on at least 1 thermometer. We found higher levels of distress in all domains associated with younger age at diagnosis. More extensive surgery (bilateral mastectomy vs unilateral mastectomy vs. lumpectomy) was correlated with higher levels of psychosocial distress. Most often cited concerns, experienced by [20 %, included eating/weight, worry about cancer, sleep problems, fatigue, anxiety, and pain. Mean clinic visit time for evaluable patients screened using the ET (n = 109) was 43.9 min (SD 18.6), compared with 42.6 min (SD 16.2) for the control group (n = 50).Conclusions. Utilizing the ET, more than one-third of women screened met criteria for psychological distress. Younger age at diagnosis and more extensive surgery were risk factors. The ET is a simple validated screening tool that identifies patients in need of further psychological evaluation without impacting clinic throughput time.Breast cancer is the most common non-skin cancer among women, with as many as 1 in 8 women diagnosed in their lifetime. 1 It is second only to lung cancer as the leading cause of death due to cancer among women. Nonetheless, diagnostics and therapeutics for breast cancer-similar to many kinds of cancer-have seen continuing improvements, leading to subsequent improvements in prognosis. Although improved prognosis often equals longer life, it does not necessarily equal improved morbidity. Therefore, there has been increasing recognition of the importance of quality of life. 2 The importance of addressing psychological distress in women with breast cancer has clearly been established. [3][4][5] In fact, the American College of Surgeons Commission on Cancer has mandated that cancer centers implement screening programs for psychosocial distress as a new criterion for accreditation. 6 Yet, barriers to care remain, including underrecognition of the need for psychological care as well as possible inciting factors. Because most conventional scales developed to detect distress and depression are too long for routine use in clinical settings, simple verbal and visual-analog measures have been developed of which the distress thermometer (DT) is perhaps the most well known. [7][8][9][10] Although a significant advance in distress screening, the DT falls short in its ability...

Prior research has used focus group methodology to investigate cultural factors impacting the breast cancer experience of women of various ethnicities including African-Americans; however, this work has not specifically addressed treatment decision-making. This study identifies key issues faced by African-American women diagnosed with breast cancer regarding treatment decisions. We used an interpretive-descriptive study design based on qualitative data from three focus groups (n = 14) representing a population of African-American women in central Pennsylvania. Participants were asked to think back to when they were diagnosed with breast cancer and their visit with the breast surgeon. Questions were asked about the actual visit, treatment choices offered, sources of information, and whether the women felt prepared for the surgery and subsequent treatments. The prompts triggered memories and encouraged open discussion. The most important themes identified were fear across the breast cancer disease trajectory, a preference for visual information for understanding the diagnosis and surgical treatment, and support systems relying on family and friends, rather than the formal health-care system. Our results have implications for practice strategies and development of educational interventions that will help breast cancer patients better understand their diagnosis and treatment options, encourage their participation in treatment decision-making, and provide psychosocial support for those at high risk for emotional distress.

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Funding informationAvon Breast Cancer Crusade K E Y W O R D S : breast cancer, exercise, metastatic, mHealth, physical function, quality of life, technology-based interventions