Cited by 502Cancer survivorship and carePalliative and Oncologic CarePatient-Provider Communication in Healthcare

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The NCCN Guideline for Distress Management: A Case for Making Distress the Sixth Vital Sign

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Holland, Jimmie C., Bultz, Barry D.·2007·Journal of the National Comprehensive Cancer Network

DOI 10.6004/jnccn.2007.0003

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Abstract

Psychosocial care of patients has traditionally been seen as separate from routine medical care and has been criticized as being “soft” and lacking evidence. This traditional perspective continues in many settings, despite the fact that patients and families, when asked, state that emotional care is highly valued. The question of how to integrate psychosocial care into routine cancer care has also been an issue, partly because of the stigma associated with cancer. In 1997, the National Comprehensive Cancer Network (NCCN) established a multidisciplinary panel to examine this problem. 1 Because patient and physician attitudes toward pain can pose similar barriers to care as with distress, the panel used as a model the rating system for assessing pain that resulted in successful improvement of pain management in the United States. The rating system’s success seemed partly based on routinely using a single question to assess a patient’s pain: “How is your pain on a scale of 0 to 10?” The system uses a score of 5 or higher as the indication to reassess pain medications or refer the patient for more expert management. This system is widely used, and patient self-report of subjective symptoms is now accepted as appropriate and reliable. Pain has become the fifth vital sign, after pulse, respiration, blood pressure, and temperature, ensuring that it is evaluated as part of routine care. Drawing on this experience, the NCCN panel recommended a simple question to ask patients about psychosocial concerns. They found that distress was the best umbrella word to represent the range of emotional concerns patients with cancer experience and that it did not carry the stigma of other words sometimes used for emotional symptoms. Several studies have now validated the approach of asking, “How is your distress on a scale of 0 to 10?” and using a score of 4 or above as the trigger for further questions and possible referral to a psychosocial service. 2,3 In 2004, the Canadian Federal Government’s public health agency, Health Canada‐Canadian Strategy for Cancer Control, approved “Emotional Distress as the 6th Vital Sign.” 4 We propose that this system should also be considered in the United States to ensure that psychosocial distress is routinely assessed as part of cancer care and managed according to the NCCN distress management guidelines. This commentary outlines the potential benefits that can accrue for patients, families, and the health care system. Over 2 years beginning in 1997, the NCCN’s multidisciplinary panel de

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Authors: Holland, J. C., & Bultz, B. D.
Affiliations: Memorial Sloan Kettering Cancer Center (US)
ORCID: Bultz, Barry D.
Venue: Journal of the National Comprehensive Cancer Network
Publisher: Harborside Press, LLC
Published: 2007-01
Volume: 5
Issue: 1
Pages: 3-7
ISSN: 1540-1405 (ISSN-L)
1540-1413
DOI: 10.6004/jnccn.2007.0003
OpenAlex: W1837710968
Cited by: 502
References: 28
Citations by year: 2026: 18 · 2025: 30 · 2024: 29 · 2023: 19 · 2022: 29 · 2021: 39 · 2020: 34 · 2019: 33 · 2018: 34 · 2017: 24 · 2016: 26 · 2015: 40 · 2014: 29 · 2013: 35 · 2012: 26
FWCI: 5.82
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of the National Comprehensive Cancer Network (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords: psychosocial distress, distress management, NCCN guidelines, cancer care, emotional distress screening, pain assessment, patient self-report
MeSH terms: Humans, Mass Screening, Medical Oncology, Neoplasms, Social Support, Stress, Psychological, Practice Guidelines as Topic

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The NCCN Guideline for Distress Management: A Case for Making Distress the Sixth Vital Sign

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