Screening and treatment of distress.

Abstract

The screening and treatment of psychological distress is an increasingly important aspect of providing comprehensive care to medical patients. The importance of this within oncology was illustrated most recently by the publication of the National Comprehensive Cancer Network's Distress Guidelines (Holland, 1997). Some of the conclusions drawn in a recent article by Coyne, Benazon, Gaba, Calzone, and Weber (2000), however, are in contrast to this position. Twenty-three percent of their sample reported emotional distress. However, because they found low rates of psychiatric diagnoses and poor concordance between distress and formal psychiatric diagnoses, the authors determined screening instruments to be inefficient and patients not in need of treatment.Given that measures of general distress assess for symptoms across diagnostic categories, it is not unusual to have a combination of symptoms indicating distress without meeting diagnostic criteria (Derogatis, Morrow, & Petting, 1983). We would suggest that general measures of distress and psychiatric diagnoses not assessed by Coyne et al. (e.g., somatoform or adjustment disorders) may reflect better the distress (health anxiety and somatic preoccupation) of women at increased risk for cancer and be more informative than assessing selectively for mood disorders, anxiety disorders, and alcohol abuse.The authors additionally concluded that ;/ there is not psychiatric disorder, then there is no impairment. They found their sample to be unimpaired with regard to counseling, education, and decision-making, yet 41% of their sample reported worries interfering with daily functioning. Unfortunately, this impairment and its significant association with distress (r = .30, p < .001) were dismissed. Moreover, they used a singleitem measure to support their conclusion. In contrast, Trask et al. (in press), using a more

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“…Findings that women receiving results of genetic testing do have elevated distress [Lodder et al, 2001] and that women receiving services at a cancer risk evaluation are low in any interference of cancer‐specific worries in their lives [Paterson et al, 2001; Trask et al, 2001] have continued to be interpreted by investigators as indicative of the need for services. Yet it may be that the mental health issues associated with genetic testing for risk of breast and ovarian cancer are being overemphasized.…”

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“…Assessment. There is currently considerable debate over how to operationalize psychobehavioral risk in medically ill patients (Benazon et al, 2002;Cavanaugh, 1995;Ketterer et al, 2002;Klinkman et al, 1998;Paterson et al, 2001;Turk & Rudy, 1988). This debate turns on old issues such as lumping versus splitting and sensitivity versus specificity.…”

Why not to screen high-risk women anticipating BRCA1/BRCA2 testing for psychological distress.

“…Dear Editor, We are writing to respond to Paterson et al's (2001) letter concerning the Coyne, Benazon, Gaba, Calzone, and Weber (2000) study, in which we reported rates of distress and major depressive disorder (MDD) of 23% and 1%, respectively, among women enrolled in a hereditary breast and ovarian cancer registry (HBOC) and anticipating an opportunity for genetic testing. These rates are lower than what is found in primary medical care samples and argue against attributing distress or MDD among these women to their being at high risk for cancer.…”

“…We also suggested that costly resources diverted to screening and diagnostic interviewing could better be applied to ensure informed consent and dissemination of test results to family members for whom the information could be life saving (Meijers-Heijboer et al, 2001). Paterson et al (2001) object that these conclusions run counter to recommendations that cancer patients routinely be screened for distress and that "No patient who is distressed should go untreated" (Holland, 1997, p. 114). Our sample consisted of high-risk women, about half of whom were survivors of cancer, not patients in acute cancer care.…”

“…Adjustment disorders are administrative diagnoses, not validated indicators of need for treatment, and somatoform disorder is rare. Paterson et al (2001) suggest that we overlooked the importance of distress not meeting formal diagnostic criteria. Yet, in contrast to MDD, interventions for distress among medical patients do not consistently show an advantage over routine care, in part because of the self-limiting nature of much of this distress (Coyne, Thompson, Palmer, Kagee, & Maunsell, 2000).…”