Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments

Abstract

Screening for emotional distress is becoming increasingly common in cancer care. This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress, with the goal of encouraging screening programs to use standardized tools that have strong psychometrics. Systematic searches of MEDLINE and PsycINFO databases for English-language studies in cancer patients were performed using a uniform set of key words (eg, depression, anxiety, screening, validation, and scale), and the retrieved studies were independently evaluated by two reviewers. Evaluation criteria included the number of validation studies, the number of participants, generalizability, reliability, the quality of the criterion measure, sensitivity, and specificity. The literature search yielded 106 validation studies that described a total of 33 screening measures. Many generic and cancer-specific scales satisfied a fairly high threshold of quality in terms of their psychometric properties and generalizability. Among the ultrashort measures (ie, those containing one to four items), the Combined Depression Questions performed best in patients receiving palliative care. Among the short measures (ie, those containing five to 20 items), the Center for Epidemiologic Studies–Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties. Among the long measures (ie, those containing 21–50 items), the Beck Depression Inventory and the General Health Questionaire–28 met all evaluation criteria. The PsychoSocial Screen for Cancer, the Questionnaire on Stress in Cancer Patients–Revised, and the Rotterdam Symptom Checklist are long measures that can also be recommended for routine screening. In addition, other measures may be considered for specific indications or disease types. Some measures, particularly newly developed cancer-specific scales, require further validation against structured clinical interviews (the criterion standard for validation measures) before they can be recommended.

No further research needed: Abandoning the Hospital and Anxiety Depression Scale (HADS)

“…Strangely, reviewers keep stumbling upon evidence pointing to these issues, sometimes noting them and usually not. They inevitably continue to recommend the HADS as a screening instrument or major depression and anxiety, although sometimes with the suggestion that the HADS needs to be recalibrated in new samples [7], which is no small task because such re-calibrations need replication that is rarely done.…”

Patient-reported depression measures in cancer: a meta-review

“…Reviews assessing outcome measures for specific cancer diagnoses (eg, breast cancer-specific measures) were also eligible, as were reviews assessing 'ultra-short' (1-4 items) and 'short' (5-20 items) instruments. 4 Types of reviews: We included published systematic (as defined by the PRISMA Statement; with or without meta-analyses) 28 and narrative reviews summarizing data collected from adults (aged 18+ years) diagnosed with any type of cancer, at any stage of the cancer experience (including palliative care and survivorship). Given the evidence that 'grey literature' plays an important role in guiding policy and practice, 30,31 we also included reviews published in reports, discussion papers, briefings, and practice guidelines.…”

“…3,4 MedLine records that 'depression' and 'cancer' were addressed together in an average of 192 citations/year in the 1980's, rising to an average of >1000 citations/year between 2006-2015. 5,6 Mirroring this rise, clinicians and researchers have utilized numerous patient-reported outcome measures to assess depression in individuals affected by cancer.…”

“…5,6 Mirroring this rise, clinicians and researchers have utilized numerous patient-reported outcome measures to assess depression in individuals affected by cancer. 4,7,8,9 Unrecognized and untreated depression can have deleterious implications for long term quality of life, 11,12 treatment adherence 13 health service use, 14,15 requests for death, 11 and mortality. [16][17][18] Opinion leaders therefore often recommend that all patients be evaluated for depressive symptoms at regular intervals across the trajectory of cancer care.…”

“…25 The IPOS Research Committee therefore conducted a meta-review (an 'overview of reviews' or For measures to assess depression see http://www.scal esandmeasures. net/search.php 4 'umbrella review' 25 ) of depression outcome measures used as screeners or casefinders in adults with or recovering from cancer. Meta-reviews present a unique approach to knowledge integration, enabling the aggregation and synthesis of multiple reviews into a single document.…”