The Distress Thermometer: Cutoff Points and Clinical Use

Purpose/Objectives: To establish an optimal cutoff point for the National Comprehensive Cancer Network's Distress Thermometer (DT) as a screening measure to identify and address psychological distress in individuals with cancer, and to examine whether distress as measured by the DT significantly changes across the treatment trajectory. Design: Secondary analyses of baseline data from a longitudinal parent study examining a computerized psychosocial assessment. Setting: Three diverse comprehensive cancer centers across the United States. Sample: 836 patients with a current or past diagnosis of cancer. Methods: Study participants were selected from a randomized clinical trial. Patients during any stage of the cancer treatment trajectory were recruited during a chemotherapy infusion or routine oncology appointment. Main Research Variables: The Behavioral Health Status Index and the DT were administered and compared using receiver operating characteristic analyses. Findings: Results support a cutoff score of 3 on the DT to indicate patients with clinically elevated levels of distress. In addition, patients who received a diagnosis within the 1-4 weeks prior to the assessment indicated the highest levels of distress. Conclusions: Providers may wish to use a cutoff point of 3 to most efficiently identify distress in a large, diverse population of patients with cancer. In addition, results indicate that patients may experience a heightened state of distress within 1-4 weeks post-diagnosis compared to other stages of coping with cancer. Implications for Nursing: Using a brief measure of distress can help streamline the process of screening for psychosocial distress.