Screening for Psychological Distress in Surgical Breast Cancer Patients

Abstract

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...

Prevalence and related factors of psychological distress among cancer inpatients using routine Distress Thermometer and Chinese Health Questionnaire screening

“…Our finding that 22.1% of the cancer inpatients had psychological distress was concordant with the previous data reporting that nearly 20%–40% of cancer patients suffered from psychological distress 15,38–42. But our result was lower than that in 2 studies on Korean cancer patients21,22 and other studies,43,44 which found a rate higher than 50%.…”

“…The DT is a 1-item self-report screening tool for evaluating psychological distress in patients with cancer 15,23,24. The DT grades distress levels over the prior week based on a visual analog scale with scores from 0 (indicating no distress) to 10 (indicating extreme distress).…”

“…However, challenges to care persist, containing not only the underestimation of the demand for psychosocial care but also the likely related factors. Since a majority of traditional tools designed to screen depression and distress are time-consuming for routine utilization in clinical situations, uncomplicated verbal and visual analog tools, such as the Distress Thermometer (DT),14 the emotions thermometer,15 and the 12-item General Health Questionnaire,16 have been recommended. Of these scales, DT is probably the most widely utilized 17–20…”

Clinical Indicators of Psychosocial Distress Predict for Acute Radiation-Induced Fatigue in Patients Receiving Adjuvant Radiation Therapy for Breast Cancer: An Analysis of Patient-Reported Outcomes

“…Two prior studies did find increased fatigue among patients treated with mastectomy, but neither study assessed RT-induced fatigue (22,38). Inasmuch as only 51 patients in our study underwent mastectomy, it is possible that the study was underpowered for the detection of a surgery effect; alternatively, the relationship between mastectomy and fatigue may be affected by psychosocial issues (39), which may have been accounted for in our multivariate analyses.…”

Psychological distress in patients with breast cancer after different antitumor treatments

“…Опрос 167 больных РМЖ, в подавляющем большинстве перенес-ших РМЭ, с помощью Госпитальной шкалы тревоги и депрессии (Hospital Anxiety and Depression Scale) на протяжении 18 мес от начала лечения показал, что у 38,4 % из них отмечался высокий уровень трево-ги и у 22,2 % -высокий уровень депрессии [17]. По данным [18], степень выраженности дистресса кор-релировала с объемом проведенной операции. Авторы пришли к такому выводу после тестирования 149 боль-ных РМЖ, выявив после оперативного вмешательства у 22 % из них психологический дистресс, у 28 % -тре-вогу и у 18 % -депрессию.…”