Measuring distress in cancer patients: The Distress Thermometer in an Australian sample

Abstract

Purpose: To evaluate the use of the Distress Thermometer in an Australian population using the Hospital Anxiety and Depression Scale (HADS) as the criterion measure for case detection. Patients and methods: A cross-sectional survey of 439 cancer patients (61.2% response) under current medical care at a regional tertiary cancer centre was undertaken. Assessments included general distress, anxiety and depression, general health and well-being, cancer-specific distress, social support, and social constraints. The screening properties of the Distress Thermometer were evaluated against cases identified using the full-scale scores of the HADS as has been done previously. In addition, we used the separate scores on the depression and anxiety scales to evaluate the utility of the Distress Thermometer in detecting cases of anxiety only, depression only, and depression and anxiety together. Results: The sensitivity and specificity of the Distress Thermometer with the HADS full scale were found to be similar to that of previous research. Use of the sub-scale scores of the HADS to detect cases led to some differences in the Distress Thermometer performance. In particular, detection of cases of depression only was quite poor. The positive predictive value (PPV) of the HADS generally and specifically was noted to be problematic. Conclusions: Although we obtained similar results to previous research, our results suggested that caution may need to be exercised when using the Distress Thermometer as a screening instrument. It may not be as effective a screen for depression symptoms and has a high rate of false positives.