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Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments
Open accessAbstract
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.
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“The HADS is validated and extensively used in the measurement of distress among cancer survivors (Vodermaier et al., 2009; Mitchell et al., 2010).”
From A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol (2021) · cites this paper as Vodermaier et al., 2009
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Cited by
Sorted by citations
Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age
Linden, W., Vodermaier, A., MacKenzie, R., & Greig, D. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.03.025 · Cited by 1,245
Krebber, A. M. H., Buffart, L. M., Kleijn, G., Riepma, I. C., de Bree, R., Leemans, C. R., Becker, A., Brug, J., van Straten, A., Cuijpers, P., et al. (2014) · Psycho-Oncology · doi:10.1002/pon.3409 · Cited by 908
“[8] previously recommended implementing routine self-report for symptoms of depression in cancer patients using valid and reliable self-report instruments, such as the HADS-D, the CES-D or the BDI.”
BackgroundMethodInfluentialScreening for Distress and Unmet Needs in Patients With Cancer: Review and Recommendations
Carlson, L. E., Waller, A., & Mitchell, A. J. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.39.5509 · Cited by 550
Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical samples
Schalet, B. D., Pilkonis, P. A., Yu, L., Dodds, N., Johnston, K. L., Yount, S., Riley, W., & Cella, D. (2016) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2015.08.036 · Cited by 507
“Not all the available instruments meet high levels of instrument development standards for reliability, validity, appropriate reading level, and minimal respondent burden[4, 5].”
BackgroundMitchell, A. J., Meader, N., & Symonds, P. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.01.067 · Cited by 394
“Studies that have used structured psychiatric interviews suggest that the prevalence of major depressive disorder is approximately 15% in advanced cancer (Vodermaier et al., 2009).”
Background
Metadata
- Authors
- Vodermaier, A., Linden, W., & Siu, C.
- Affiliations
- BC Cancer Agency (CA)
- Corresponding author
- Vodermaier, A.
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-10-13
- Volume
- 101
- Issue
- 21
- Pages
- 1464-1488
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC3298956
- OpenAlex
- W1996766132
- Cited by
- 541
- References
- 160
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 30 · 2023: 20 · 2022: 27 · 2021: 34 · 2020: 24 · 2019: 32 · 2018: 49 · 2017: 28 · 2016: 32 · 2015: 42 · 2014: 38 · 2013: 52 · 2012: 48
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Canadian Institutes of Health Research (#AQC83559)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- emotional distress screening, cancer patients, psychometric properties, depression screening, anxiety screening, screening tool, scale validation, CES-D, Hospital Anxiety and Depression Scale, Beck Depression Inventory, Rotterdam Symptom Checklist, palliative care, sensitivity and specificity
- MeSH terms
- Adjustment Disorders, Anxiety Disorders, Depression, Depressive Disorder, Major, Major Depressive Disorder, Humans, Mass Screening, Neoplasms, Psychometrics, Surveys and Questionnaires, Stress, Psychological, Reproducibility of Results, Dysthymic Disorder
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