The German version of the NCCN Distress Thermometer:: Validation of a screening instrument for assessment of psychosocial distress in cancer patients

The NCCN Distress-Thermometer is a brief screening tool for cancer patients to assess distress. It has been developed by the National Comprehensive Cancer Network (NCCN) in the US. It consists of a scale from 0-10 and a problem list which provides information to which health care professionals a patient should be referred. A score of 5 is internationally recommended as an indicator that a patient is distressed and needs support. For the German adaptation, a sample of n = 475 cancer patients was assessed during oncological rehabilitation. To validate the screening tool, we used the Hospital Anxiety and Depression Scale (HAD-D) and the brief version of the Fear of Progression Questionnaire (PA-F 1,2). The discriminating power of the Distress-Thermometer was particularly good when screening,for higher levels of anxiety or/and depression (HADS Cut-off > 11): AUC from 0.71 to 0.76. For a score of 5 in the Distress-Thermometer, we found a sensitivity up to 84% and a lower specifity up to 47 % when screening for moderate levels of anxiety or/and depression (HADS Cut-off > 8). Screening for a higher level of distress (HADS Cut-off > 11), we found a sensitivity up to 97 % and a specifity up to 41 % when using a score of 5 in the Distress Thermometer. The specifity of the instrument is lower as the values for specifity found in international studies, but the sensitivity is little higher in the German sample. Due to its high acceptance, its brevity and practice orientation, the NCCN Distress-Thermometer can be recommended as a screening tool to assess psychosocial distress in cancer patients.