A systematic review of the translation and validation methods used for the national comprehensive cancer network distress thermometer in non‐English speaking countries

Abstract

Objective The National Comprehensive Cancer Network (NCCN) distress thermometer (DT) was developed as a brief screening tool for detecting distress in cancer patients. Conceptually, distress was considered a more acceptable and inclusive term than other psychological terms such as depression or anxiety. It is used extensively in the United States and other English‐speaking countries. We aim to describe the translation and validation methods of the DT and describe the recommended cutoff scores used to identify cancer patients experiencing clinically significant distress. Methods Nine bibliographic databases were searched using keywords to identify original research studies for non‐English speaking countries' cancer patients. Full articles were independently assessed for inclusion and data extraction by two authors. Results The review of 4442 articles yielded 39 articles that validated the DT. We identified 20 languages in 25 countries. In all but one country, investigators were able to agree upon a word or phrase that meant distress in their native language that was subsequently validated against standardized instruments. Asian, Middle Eastern and European counties recommended cutoff score of 4 or 5 to identify clinically significant distress; however, European Union countries had a range of 2 to 7. Conclusions Use of the translated DT with non‐English speaking cancer patients provides a simple and quick tool to identify high distress. Similar to NCCN, the cutoff score of 4 or 5 was suggested by 78% of the studies; however, more studies of different types of cancer and within and among more countries will strengthen a recommended global DT cutoff score.

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“…It superimposes Numeric Rating and Visual Analogue Scales over a vertical thermometer ranging from 0 (no distress) to 10 (extreme distress), alongside a 40-item checkbox problem list meant to specify the etiology of reported distress. Conceptually, distress was considered a more acceptable and inclusive term than other psychological terms such as depression or anxiety (McElroy et al, 2022). The NCCN DT was created by Roth et al (1998) as a means for rapid psychological distress screening for oncologists whose allotted clinic time with each patient was diminishing.…”

“…The National Comprehensive Cancer Network adopted the Distress Thermometer in 1997, and it is now the screening instrument most widely used to detect the presence of distress in cancer patients. The most recent version of the NCCN practice guidelines for the management of distress recommends that a NCCN DT score of four or higher indicates moderate-severe distress (McElroy et al, 2022). Cutillo and colleagues compared the NCCN DT and Behavioral Health Status index in a sample of 836 cancer patients at three diverse comprehensive cancer centers and found a statistically significant correlation (rho = 0.58, p < .0001) (Cutillo et al, 2017).…”

“…The cutoff score of ≥3 was used to determine the threshold value of the impact of distress on cancer patients, validating the NCCN DT as an appropriate screening instrument in the newly diagnosed cancer population. Discriminant validity of the NCCN DT has been proven many times against other validated tools measuring anxiety and depression such as the HADS (Cutillo et al, 2017, McElroy et al, 2022Thapa et al, 2020). Per the most recent systematic review of NCCN DT literature, it has been translated into 20 languages in 25 countries (McElroy, et al, 2022).…”

“…Discriminant validity of the NCCN DT has been proven many times against other validated tools measuring anxiety and depression such as the HADS (Cutillo et al, 2017, McElroy et al, 2022Thapa et al, 2020). Per the most recent systematic review of NCCN DT literature, it has been translated into 20 languages in 25 countries (McElroy, et al, 2022). Though the NCCN DT is the most widely used screening instrument for distress in the oncology population, it does not discriminate between different types of anxiety, nor between anxiety and depression.…”