Cited by 405Cancer survivorship and careChildhood Cancer Survivors' Quality of LifePalliative and Oncologic Care

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Screening and referral for psychosocial distress in oncologic practice: Use of the Distress Thermometer

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Tuinman, Marrit A., Gazendam‐Donofrio, Stacey M., Hoekstra‐Weebers, Josette E.·2008·Cancer

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Abstract

BACKGROUND.: The objectives of this study were to validate the Distress Thermometer (DT) in the Netherlands and to examine its correspondence with a 46‐item Problem List, possible risk factors, and the wish for a referral. METHODS.: A cross‐sectional group of 277 cancer patients who were treated at 9 hospitals filled in the DT and the Hospital Anxiety and Depression Scale and rated the presence and severity of problems (response rate, 49%). RESULTS.: Receiver operating characteristic analyses identified an ideal cutoff score of 5 on the DT with a positive predictive value of 39% and a negative predictive value of 95%. The Problem List appeared to be a reliable measure. Five items on the Problem List correlated strongly with the DT, 13 items had a moderately strong correlation, 26 items were correlated weakly, and 2 items were not correlated significantly. Emotional control, nervousness, pain, and physical fitness appeared to contribute independently to the DT score. The percentage of patients scoring ≥5 (n = 118 patients; 43%) who wanted (14%) or maybe wanted (29%) a referral was significantly higher than the percentage of patients with DT scores <5 (5% and 13%, respectively) who wanted or maybe wanted a referral. Intensively treated patients reported more distress than those who only underwent surgery. No other clear risk factors for distress were identified. CONCLUSIONS.: The DT appeared to be a good instrument for routine screening and ruling out elevated distress. Emotional and physical problems contributed mainly to distress. Experiencing clinically elevated distress did not necessarily suggest that patients wanted a referral. Screening for distress and the wish for a referral can facilitate providing support for those patients who most need and want it. Cancer 2008. © 2008 American Cancer Society.

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BackgroundMethodInfluentialSelf-citation
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Background
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Souwer, E. T. D., Bastiaannet, E., de Bruijn, S., Breugom, A. J., van den Bos, F., Portielje, J. E. A., & Dekker, J. W. T. (2018) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2018.08.028 · Cited by 60
The Cancer Empowerment Questionnaire: Psychological Empowerment in Breast Cancer Survivors
van den Berg, S. W., van Amstel, F. K. P., Ottevanger, P. B., Gielissen, M. F. M., & Prins, J. B. (2013) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2013.825361 · Cited by 58
The Distress Thermometer and Its Validity: A First Psychometric Study in Indonesian Women with Breast Cancer
Iskandarsyah, A., de Klerk, C., Suardi, D. R., Soemitro, M. P., Sadarjoen, S. S., & Passchier, J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0056353 · Cited by 58
“In contrast, most studies conducted in Western countries found that clinically significant distress was not associated with spiritual/religious concerns [20,22,24], or only weakly related [34].”
Result
Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire: development and testing of a screening questionnaire for use in clinical cancer genetics
Eijzenga, W., Bleiker, E. M. A., Hahn, D. E. E., Kluijt, I., Sidharta, G. N., Gundy, C. M., & Aaronson, N. K. (2014) · Psycho-Oncology · doi:10.1002/pon.3485 · Cited by 57
“The Distress Thermometer (DT), a visual analog scale ranging from 0 to 10 (‘no distress’ to ‘extreme distress’), was also added to the questionnaire as a measure of general psychological distress [23].”
Method
The utility of the Edmonton Symptom Assessment System in screening for anxiety and depression
Bagha, S., MACEDO, A., Jacks, L. M., Lo, C., Zimmermann, C., Rodin, G., & Li, M. (2012) · European Journal of Cancer Care · doi:10.1111/j.1365-2354.2012.01369.x · Cited by 57
“2004) and the Distress Thermometer (DT) (Tuinman et al. 2008; Lynch et al. 2010; Bidstrup et al. 2012).”
Health concerns of cancer survivors after primary anti-cancer treatment
Tan, S. Y., Turner, J., Kerin-Ayres, K., Butler, S., Deguchi, C., Khatri, S., Mo, C., Warby, A., Cunningham, I., Malalasekera, A., et al. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-04664-w · Cited by 55
The detection of depression in palliative care
Rayner, L., Loge, J. H., Wasteson, E., & Higginson, I. J. (2009) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0b013e328326b59b · Cited by 54
Usage of a Generic Web-Based Self-Management Intervention for Breast Cancer Survivors: Substudy Analysis of the BREATH Trial
van den Berg, S. W., Peters, E. J., Kraaijeveld, J. F., Gielissen, M. F., & Prins, J. B. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2566 · Cited by 53
“In addition to the intervention ingredients, Distress thermometers [22] are available to track the course of experienced distress over the 4-month intervention.”
Background
Bilateral Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is Not Effective: A Randomised Controlled Trial
Hoekstra, C. E. L., Versnel, H., Neggers, S. F. W., Niesten, M. E. F., & van Zanten, G. A. (2013) · Audiology and Neurotology · doi:10.1159/000354977 · Cited by 53
“…thermometer used with cancer patients, asking the patients to indicate the amount of overall burden experienced that day on an 11-point scale ranging from 0 to 10 (‘no’ to ‘extreme distress’), with half-scores when patients scored in-between numbers [Roth et al., 1998; Tuinman et al., 2008].”
Method
Stepped care targeting psychological distress in head and neck and lung cancer patients: a randomized clinical trial
Krebber, A.-M. H., Leemans, C. R., de Bree, R., van Straten, A., Smit, F., Smit, E. F., Becker‐Commissaris, A., Eeckhout, G. M., Beekman, A. T. F., Cuijpers, P. J., et al. (2012) · BMC Cancer · doi:10.1186/1471-2407-12-173 · Cited by 53
“There is a rising need towards screening for physical and psychosocial problems and the need for supportive care in routine clinical practice through patient-reported outcomes (PRO’s) [50-54].”
Background
The Distress Thermometer: a rapid and effective tool for the oncology social worker
O'Donnell, E., D’Alton, P., O'Malley, C., Gill, F., & Canny, Á. (2013) · International Journal of Health Care Quality Assurance · doi:10.1108/09526861311319573 · Cited by 52
Patient-reported outcome measures in oncology: a qualitative study of the healthcare professional’s perspective
Graupner, C., Breukink, S. O., Mul, S., Claessens, D., Slok, A. H. M., & Kimman, M. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06052-9 · Cited by 51
Distress, anxiety, depression, and emotional well-being in African-American men with prostate cancer
Nelson, C. J., Balk, E. M., & Roth, A. J. (2010) · Psycho-Oncology · doi:10.1002/pon.1659 · Cited by 49
“This scale has demonstrated good convergent and discriminant validity in studies with cancer patients as compared with longer measures used to screen for distress [32,33] Research suggests that a cut-off of 4 or greater warrants referral for mental health assessments [32].”
Result
Rationale of the BREAst cancer e-healTH [BREATH] multicentre randomised controlled trial: An Internet-based self-management intervention to foster adjustment after curative breast cancer by decreasing distress and increasing empowerment
van den Berg, S. W., Gielissen, M. F. M., Ottevanger, P. B., & Prins, J. B. (2012) · BMC Cancer · doi:10.1186/1471-2407-12-394 · Cited by 50
“General distress will be measured with the Dutch version of the Distress Thermometer (DT) [47].”
Method
Feasibility and Impact of a Physical Exercise Program in Patients with Advanced Cancer: A Pilot Study
van den Dungen, I. A., Verhagen, C. A. H. H. V. M., van der Graaf, W. T. A., van den Berg, J., Vissers, K. C. P., & Engels, Y. (2014) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0638 · Cited by 48
“Also, the Edmonton Symptom Assessment System (ESAS) and the Dutch version of the Distress Thermometer (DT) were used to measure total symptom distress score and number of ADL problems.(35,36)”
Using the distress thermometer and hospital anxiety and depression scale to screen for psychosocial morbidity in patients diagnosed with colorectal cancer
Patel, D., Sharpe, L., Thewes, B., Bell, M. L., & Clarke, S. J. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.11.014 · Cited by 48
The suitability of the Hospital Anxiety and Depression Scale, Distress Thermometer and other instruments to screen for psychiatric disorders in both lung cancer patients and their partners
Schellekens, M. P. J., van den Hurk, D. G. M., Prins, J. B., Molema, J., van der Drift, M. A., & Speckens, A. E. M. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.05.044 · Cited by 48
Systematic screening for distress in oncology practice using the Distress Barometer: the impact on referrals to psychosocial care
Bauwens, S., Baillon, C., Distelmans, W., & Theuns, P. (2014) · Psycho-Oncology · doi:10.1002/pon.3484 · Cited by 47
Adopting a family approach to theory and practice: measuring distress in cancer patient–partner dyads with the distress thermometer
Zwahlen, D., Hagenbuch, N., Jenewein, J., Carley, M. I., & Büchi, S. (2010) · Psycho-Oncology · doi:10.1002/pon.1744 · Cited by 47
“Therefore, whether and why selected patients and family members actually consent to or ask for psycho-oncological support is an essential issue, one that researchers have only recently begun to address [48–50].”
Background
Adoption and implementation of a web-based self-management application “Oncokompas” in routine cancer care: a national pilot study
de Wit, L. M., van Uden‐Kraan, C. F., Lissenberg-Witte, B. I., Melissant, H. C., Fleuren, M. A. H., Cuijpers, P. J., & Leeuw, I. M. V. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4591-5 · Cited by 48
Palliative care needs at different phases in the illness trajectory: a survey study in patients with cancer
Beernaert, K., Pardon, K., den Block, L. V., Devroey, D., Laat, M. D., Geboes, K. P., Surmont, V. F. M., Deliëns, L., & Cohen, J. (2016) · European Journal of Cancer Care · doi:10.1111/ecc.12522 · Cited by 46
The impact of physical activity on fatigue and quality of life in lung cancer patients: a randomised controlled trial protocol
Dhillon, H. M., van der Ploeg, H. P., Bell, M. L., Boyer, M. J., Clarke, S. J., & Vardy, J. L. (2012) · BMC Cancer · doi:10.1186/1471-2407-12-572 · Cited by 48
“Other exploratory endpoints relating to physical activity and fitness will include: anxiety and depression (General Health Questionnaire 12) [48]; distress (Distress Thermometer) [49], perceived cognitive function (FACT-Cognition v3) [50], sleep quality (Pittsburgh Sleep Quality Index) [51], dyspnoea (University of Ca…”
Method
The impact of a cancer Survivorship Care Plan on gynecological cancer patient and health care provider reported outcomes (ROGY Care): study protocol for a pragmatic cluster randomized controlled trial
van de Poll-Franse, L. V., Nicolaije, K. A. H., Vos, M. C., Pijnenborg, J. M. A., Boll, D., Husson, O., Ezendam, N. P. M., Boss, E. A., Hermans, R. H. M., Engelhart, K. C. M., et al. (2011) · Trials · doi:10.1186/1745-6215-12-256 · Cited by 45
Educational intervention in cancer outpatient clinics on routine screening for emotional distress: an observational study
Grassi, L. G., Rossi, E. G., Caruso, R., Nanni, M. G., Pedrazzi, S., Sofritti, S., & Sabato, S. (2011) · Psycho-Oncology · doi:10.1002/pon.1944 · Cited by 44
Study protocol of the SWORD-study: a randomised controlled trial comparing combined online and face-to-face cognitive behaviour therapy versus treatment as usual in managing fear of cancer recurrence
van de Wal, M., Gielissen, M. F. M., Servaes, P., Knoop, H., Speckens, A. E. M., & Prins, J. B. (2015) · BMC Psychology · doi:10.1186/s40359-015-0068-1 · Cited by 44
“In addition, the Dutch version of the Distress Thermometer (DT) and the problem list will be completed as well (Tuinman et al. 2008).”
Background
Distress, problems and supportive care needs of patients treated with auto- or allo-SCT
Braamse, A. M. J., van Meijel, B., Visser, O. J., Huijgens, P. C., Beekman, A. T. F., & Dekker, J. (2013) · Bone Marrow Transplantation · doi:10.1038/bmt.2013.155 · Cited by 43
Prevalence and related factors of psychological distress among cancer inpatients using routine Distress Thermometer and Chinese Health Questionnaire screening
Chiou, Y., Chiu, N., Wang, L., Li, S.-H., Lee, C., Wu, M., Chen, C., Wu, Y., & Lee, Y. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s118667 · Cited by 41
Seeking, accepting and declining help for emotional distress in cancer: A systematic review and thematic synthesis of qualitative evidence
Carolan, C. M., Smith, A., Davies, G., & Forbat, L. (2017) · European Journal of Cancer Care · doi:10.1111/ecc.12720 · Cited by 41
A Specific Distress Cutoff Score Shortly After Breast Cancer Diagnosis
van Amstel, F. K. P., Tol, J., Sessink, K., van der Graaf, W. T. A., Prins, J. B., & Ottevanger, P. B. (2016) · Cancer Nursing · doi:10.1097/ncc.0000000000000380 · Cited by 40
Screening for depression and diabetes‐related distress in a diabetes outpatient clinic
Fleer, J., Tovote, K. A., Keers, J. C., Links, T. P., Sanderman, R., Coyne, J. C., & Schroevers, M. J. (2012) · Diabetic Medicine · doi:10.1111/dme.12001 · Cited by 39
The consumer-driven development and acceptability testing of a website designed to connect rural cancer patients and their families, carers and health professionals with appropriate information and psychosocial support
Gunn, K. M., Turnbull, D. A., Bidargaddi, N. P., McWha, J. L., Davies, M., & Olver, I. (2016) · European Journal of Cancer Care · doi:10.1111/ecc.12533 · Cited by 41
Study protocol of a randomized controlled trial comparing Mindfulness-Based Stress Reduction with treatment as usual in reducing psychological distress in patients with lung cancer and their partners: the MILON study
Schellekens, M. P. J., van den Hurk, D. G. M., Prins, J. B., Molema, J., Donders, A. R. T., Woertman, W. H., van der Drift, M. A., & Speckens, A. E. M. (2014) · BMC Cancer · doi:10.1186/1471-2407-14-3 · Cited by 38
“After that, baseline questionnaires, including the Distress Thermometer (DT) [34,35], are administered, followed by randomization.”
Method
Survivorship Care Plans to inform the primary care physician: results from the ROGY care pragmatic cluster randomized controlled trial
Ezendam, N. P. M., Nicolaije, K. A. H., Kruitwagen, R. F. P. M., Pijnenborg, J. M. A., Vos, M. D., Boll, D., van Bommel, M., & van de Poll-Franse, L. V. (2014) · Journal of Cancer Survivorship · doi:10.1007/s11764-014-0368-0 · Cited by 40
Effect of Routine Assessment of Specific Psychosocial Problems on Personalized Communication, Counselors' Awareness, and Distress Levels in Cancer Genetic Counseling Practice: A Randomized Controlled Trial
Eijzenga, W., Aaronson, N. K., Hahn, D. E. E., Sidharta, G. N., van der Kolk, L. E., Velthuizen, M. E., Ausems, M. G. E. M., & Bleiker, E. M. A. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2014.55.4576 · Cited by 38
The Sequelae of Anxiety in Breast Cancer: A Human Response to Illness Model
Pedersen, A. E., Sawatzky, J. V., & Hack, T. F. (2010) · Oncology nursing forum · doi:10.1188/10.onf.469-475 · Cited by 37
Short‐term multimodal prehabilitation improves functional capacity for colorectal cancer patients prior to surgery
Suen, M., Liew, A., Turner, J. D., Khatri, S., Lin, Y., Raso, K.-L., & Vardy, J. L. (2021) · Asia-Pacific Journal of Clinical Oncology · doi:10.1111/ajco.13564 · Cited by 37
Distress Thermometer in breast cancer: systematic review and meta-analysis
Sun, H., Lv, H., Zeng, H., Niu, L., & Yan, M. (2021) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2021-002960 · Cited by 37
Anxiety and depression in oncology patients; a longitudinal study of a screening, assessment and psychosocial support intervention
Thalén-Lindström, A., Larsson, G., Glimelius, B. L. G., & Johansson, B. (2012) · Acta Oncologica · doi:10.3109/0284186x.2012.707785 · Cited by 37
Measurement of distress in Chinese inpatients with lymphoma
Wang, Y., Zou, L., Jiang, M., Wei, Y., & Jiang, Y. (2012) · Psycho-Oncology · doi:10.1002/pon.3170 · Cited by 36
Distress, problems and referral wish of cancer patients: differences according to relationship status and life phase
Tuinman, M. A., van Nuenen, F. M., Hagedoorn, M., & Hoekstra‐Weebers, J. E. H. M. (2014) · Psycho-Oncology · doi:10.1002/pon.3712 · Cited by 36
“Earlier studies showed that having high distress does not necessarily imply a need for additional care, as around half of distressed patients does not want further help [25].”
BackgroundMethodInfluentialSelf-citation
The usefulness and feasibility of a screening instrument to identify psychosocial problems in patients receiving curative radiotherapy: a process evaluation
Braeken, A. P. B. M., Kempen, G. I. J. M., Eekers, D. B. P., van Gils, F. C. J. M., Houben, R. M. A., & Lechner, L. (2011) · BMC Cancer · doi:10.1186/1471-2407-11-479 · Cited by 36
“Several studies examined the use of screening instruments [12-16].”
Background
Validation of the Dutch version of the Edmonton Symptom Assessment System
van der Baan, F. H., Koldenhof, J. J., de Nijs, E. J. M., Echteld, M. A., Zweers, D., Hesselmann, G. M., Vervoort, S. C. J. M., Vos, J. B. H., de Graaf, E., Witteveen, P. O., et al. (2020) · Cancer Medicine · doi:10.1002/cam4.3253 · Cited by 37
Professional patient navigation in a hospital setting: a randomized controlled trial
Berezowska, A., Passchier, E., & Bleiker, E. M. A. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05721-5 · Cited by 36
The Association of Cancer Patients’ Emotional Suppression and Their Self-Rating of Psychological Distress on Short Screening Tools
Cohen, M. W. (2013) · Behavioral Medicine · doi:10.1080/08964289.2012.731440 · Cited by 35
Cancer patients' referral wish: effects of distress, problems, socio-demographic and illness-related variables and social support sufficiency
Admiraal, J. M., van Nuenen, F. M., Burgerhof, J. G. M., Reyners, A. K. L., & Hoekstra‐Weebers, J. E. H. M. (2016) · Psycho-Oncology · doi:10.1002/pon.4067 · Cited by 35
“The last question of the Dutch DT/PL covers patients’ referral wish to a psychosocial or paramedical healthcare professional [14].”
BackgroundMethodResultInfluentialSelf-citation
Effectiveness of disease-specific cognitive–behavioural therapy on depression, anxiety, quality of life and the clinical course of disease in adolescents with inflammatory bowel disease: study protocol of a multicentre randomised controlled trial (HAPPY-IBD)
van den Brink, G., Stapersma, L., Marroun, H. E., Henrichs, J., Szigethy, E., Utens, E. M. W. J., & Escher, J. C. (2016) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2015-000071 · Cited by 34

Authors: Tuinman, M. A., Gazendam‐Donofrio, S. M., & Hoekstra‐Weebers, J. E.
Corresponding author: Hoekstra‐Weebers, Josette E.
ORCID: Tuinman, Marrit A.
Hoekstra‐Weebers, Josette E.
Venue: Cancer
Publisher: Wiley
Published: 2008-07-10
Volume: 113
Issue: 4
Pages: 870-878
ISSN: 0008-543X (ISSN-L)
1097-0142
DOI: 10.1002/cncr.23622
OpenAlex: W1560769006
Cited by: 404
References: 42
Citations by year: 2026: 11 · 2025: 23 · 2024: 10 · 2023: 21 · 2022: 23 · 2021: 22 · 2020: 18 · 2019: 29 · 2018: 25 · 2017: 26 · 2016: 35 · 2015: 19 · 2014: 24 · 2013: 34 · 2012: 29
FWCI: 9.52
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Cancer (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords: psychosocial distress, cancer patients, Distress Thermometer, screening, referral, problem list, anxiety, depression, emotional control, pain, risk factors, psychosocial support
MeSH terms: Adult, Aged, Aged, 80 and over, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Male, Middle Aged, Neoplasms, Predictive Value of Tests, Psychometrics, Referral and Consultation, Risk Factors, Stress, Psychological

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Screening and referral for psychosocial distress in oncologic practice: Use of the Distress Thermometer

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