Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting

Background: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. Aim: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. Design: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. Setting/Participants: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. Results: The area under the curve was optimal using a Distress Thermometer cut-off score of > 6 for total distress and for anxiety, and a cut-off score of > 4 optimal when screening for depression. Conclusions: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of > 5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.

Automated summary

The Distress Thermometer is a valid and accurate screening tool for advanced cancer patients, but caution is needed due to lack of specificity. In this study with 139 participants providing complete data, the optimal cut-off score on the Distress Thermometer was > 6 for total distress and anxiety, and > 4 for depression in patients with advanced cancer.