Receiving a diagnosis of cancer is often a traumatic experience, and can cause severe distress. There is a need for screening tools that optimize cost-benefit while preventing the risk of underestimating levels of distress in cancer patients.
The aim of this study was to compare the Distress Thermometer (DT) to the Hospital Anxiety and Depression Scale (HADS), defining an optimal cut-off score of the DT in this population.
477 consecutive women newly diagnosed with breast cancer in the Breast Unit of the San Giovanni Battista Hospital in Turin, Italy, were screened through a routine pre-surgery program. The inclusion criteria were: 1. histologically or cytologically confirmed breast cancer (Stages I–III) 2. age>18 years. The exclusion criteria were: 1. presence of psychotic disorders and 2. previous diagnosis of cancer. Participants completed the DT and the HADS, in the period between the diagnosis and surgery.
DT correlates slightly more significantly with the anxiety dimension (HADS-A) (r=0.69, p<0.001) than depression (HADS-D) (r=0.61, p<0.001). The Receiver Operating Characteristic (ROC) curve analyses of DT scores generated an estimated Area Under the Curve (AUC) of 0.84 (95% CI 0.80–0.87) when compared to the HADS-A cut-off score, and an AUC of 0.81 95% CI 0.77–0.85) related to HADS-D. The DT cut-off score of >4 showed an optimal combination of sensitivity and specificity for anxiety (sensitivity=85%, specificity=67%) while for depression, a cut-off of >5 maximized sensitivity (70%) and specificity (75%). Regarding the HADS – Total score, a score of DT>4 indicated acceptable sensitivity (89%) and specificity (64%), with a Positive Predictive Value of 87,9% and a Negative Predictive Value of 66,8%.
The single-item DT, followed by a comprehensive assessment, appeared to be an adequate routine screening tool in detecting distress as compared to the HADS. Limits of the research and future direction will be discussed.