One-minute time interval estimation as a novel ultrashort tool for distress screening

  • Nikolay Vladimirov ConevEmail author
  • Ivan Shterev Donev
  • Dragomir Svetozarov Stoyanov
Original Article



Our study explores the potential relationship between time estimation and level of distress in cancer patients prior to starting chemotherapy.


Time estimation was assessed in 262 chemonaïve patients with solid tumors by evaluating each subject’s prospective estimation of how fast 1 min passed compared to the actual time. The median value (40 s) of time estimation was used to stratify the patients into two categories of fast and slow time estimation. The National Comprehensive Cancer Network Distress Thermometer was used at the beginning of treatment to evaluate levels of distress. Patients scoring 4 or above (51.9%) were regarded as having high levels of distress.


The pattern of the time estimation distributions significantly changed according to the level of distress. Patients with a fast time estimation had significantly higher levels of distress (4.55 ± 3.1) than patients with a slow time estimation (3.3 ± 2.9) (p = 0.001). ROC analysis revealed that at the optimal cutoff value of time estimation, patients with low and high distress levels can be discriminated with an AUC = 0.60 (95% CI: 0.53–0.67, p = 0.005) and with a sensitivity of 62.5% and specificity of 53.2%. Moreover, in a multivariate logistic regression model, fast time estimation was an independent predictor of high levels of distress.


Time estimation is a novel potent indicator of high levels of distress in cancer patients. This test is an easily performed, time-saving, and nonintrusive ultrashort screening tool that is even suitable for patients who are not willing to reveal their level of distress via direct questionnaires.


Time estimation Distress Cancer Oncology Screening 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

Informed consent

For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Network NCC (2007) Clinical practice guidelines in oncology: distress management (v. 1.2008). Accessed 26 Nov 2014
  2. 2.
    Jacobsen PB, Donovan KA, Trask PC, Fleishman SB, Zabora J, Baker F, Holland JC (2005) Screening for psychologic distress in ambulatory cancer patients. Cancer 103(7):1494–1502. CrossRefPubMedGoogle Scholar
  3. 3.
    McGregor BA, Antoni MH (2009) Psychological intervention and health outcomes among women treated for breast cancer: a review of stress pathways and biological mediators. Brain Behav Immun 23(2):159–166. CrossRefPubMedGoogle Scholar
  4. 4.
    Kennard BD, Stewart SM, Olvera R, Bawdon RE, Lewis CP, Winick NJ (2004) Nonadherence in adolescent oncology patients: preliminary data on psychological risk factors and relationships to outcome. J Clin Psychol Med Settings 11(1):31–39CrossRefGoogle Scholar
  5. 5.
    Essen L, Larsson G, Öberg K, Sjödén P-O (2002) ‘Satisfaction with care’: associations with health-related quality of life and psychosocial function among Swedish patients with endocrine gastrointestinal tumours. Eur J Cancer Care 11(2):91–99CrossRefGoogle Scholar
  6. 6.
    Skarstein J, Aass N, Fosså SD, Skovlund E, Dahl AA (2000) Anxiety and depression in cancer patients: relation between the hospital anxiety and depression scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res 49(1):27–34CrossRefGoogle Scholar
  7. 7.
    Newell SA, Sanson-Fisher RW, Savolainen NJ (2002) Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst 94(8):558–584CrossRefGoogle Scholar
  8. 8.
    Fisch M (2004) Treatment of depression in cancer. JNCI Monographs 2004(32):105–111CrossRefGoogle Scholar
  9. 9.
    Ma X, Zhang J, Zhong W, Shu C, Wang F, Wen J, Zhou M, Sang Y, Jiang Y, Liu L (2014) The diagnostic role of a short screening tool--the distress thermometer: a meta-analysis. Support Care Cancer 22(7):1741–1755. CrossRefGoogle Scholar
  10. 10.
    Mitchell AJ (2007) Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol 25(29):4670–4681. CrossRefPubMedGoogle Scholar
  11. 11.
    Tuinman MA, Gazendam-Donofrio SM, Hoekstra-Weebers JE (2008) Screening and referral for psychosocial distress in oncologic practice: use of the distress thermometer. Cancer 113(4):870–878. CrossRefPubMedGoogle Scholar
  12. 12.
    Hoffman BM, Zevon MA, D'Arrigo MC, Cecchini TB (2004) Screening for distress in cancer patients: the NCCN rapid-screening measure. Psychooncology 13(11):792–799. CrossRefPubMedGoogle Scholar
  13. 13.
    Baum SK, Boxley RL, Sokolowski M (1984) Time perception and psychological well-being in the elderly. Psychiatr Q 56(1):54–61CrossRefGoogle Scholar
  14. 14.
    Zakay D, Block RA (1997) Temporal cognition. Curr Dir Psychol Sci 6(1):12–16CrossRefGoogle Scholar
  15. 15.
    Wittmann M, Lehnhoff S (2005) Age effects in perception of time. Psychol Rep 97(3):921–935. CrossRefPubMedGoogle Scholar
  16. 16.
    Wearden JH (2004) Decision processes in models of timing. Acta Neurobiol Exp (Wars) 64(3):303–317Google Scholar
  17. 17.
    Holland JC (1997) Preliminary guidelines for the treatment of distress. Oncology (Williston Park) 11(11A):109–114 discussion 115-107Google Scholar
  18. 18.
    Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379CrossRefGoogle Scholar
  19. 19.
    Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12(2):160–174CrossRefGoogle Scholar
  20. 20.
    Funk R, Cisneros C, Williams RC, Kendall J, Hamann HA (2016) What happens after distress screening? Patterns of supportive care service utilization among oncology patients identified through a systematic screening protocol. Support Care Cancer 24(7):2861–2868PubMedGoogle Scholar
  21. 21.
    Mehnert A, Hartung TJ, Friedrich M et al. (2018) One in two cancer patients is significantly distressed: prevalence and indicators of distress. Psycho-Oncology 27:75–82. CrossRefPubMedGoogle Scholar
  22. 22.
    Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncology 10(1):19–28CrossRefGoogle Scholar
  23. 23.
    Herschbach P, Keller M, Knight L, Brandl T, Huber B, Henrich G, Marten-Mittag B (2004) Psychological problems of cancer patients: a cancer distress screening with a cancer-specific questionnaire. Br J Cancer 91(3):504–511CrossRefGoogle Scholar
  24. 24.
    Hegel MT, Moore CP, Collins ED, Kearing S, Gillock KL, Riggs RL, Clay KF, Ahles TA (2006) Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer. Cancer 107(12):2924–2931CrossRefGoogle Scholar
  25. 25.
    van Laarhoven HW, Schilderman J, Verhagen CA, Prins JB (2011) Time perception of cancer patients without evidence of disease and advanced cancer patients in a palliative, end-of-life-care setting. Cancer Nurs 34(6):453–463CrossRefGoogle Scholar
  26. 26.
    Ando M, Morita T, Akechi T, Okamoto T, Care JTFS (2010) Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. J Pain Symptom Manag 39(6):993–1002CrossRefGoogle Scholar
  27. 27.
    Foley H, Matlin M (2010) Sensation and perception, 5th edn. Taylor & Francis Group, New YorkGoogle Scholar
  28. 28.
    Zakay D (1990) The evasive art of subjective time measurement: some methodological dilemmas. In: Block RA (ed) Cognitive models of psychological time. Lawrence Erlbaum Associates, HillsdaleGoogle Scholar
  29. 29.
    Brown SW, Stubbs DA (1988) The psychophysics of retrospective and prospective timing. Perception 17(3):297–310CrossRefGoogle Scholar
  30. 30.
    Fraisse P (1984) Perception and estimation of time. Annu Rev Psychol 35(1):1–37CrossRefGoogle Scholar
  31. 31.
    Holland JC, Bultz BD (2007) The NCCN guideline for distress management: a case for making distress the sixth vital sign. J Natl Compr Cancer Netw 5(1):3–7CrossRefGoogle Scholar
  32. 32.
    Tuinman MA, Gazendam-Donofrio SM, Hoekstra-Weebers JE (2008) Screening and referral for psychosocial distress in oncologic practice. Cancer 113(4):870–878CrossRefGoogle Scholar
  33. 33.
    Bellè M, Muzzatti B, Tomas M, Gherlinzoni F (2016) Psychological screening of onco-hematologic inpatients: distress thermometer administration. Tumori 102(2):178–183CrossRefGoogle Scholar
  34. 34.
    Steele R, Fitch MI (2008) Why patients with lung cancer do not want help with some needs. Support Care Cancer 16(3):251–259CrossRefGoogle Scholar
  35. 35.
    Fallowfield L, Ratcliffe D, Jenkins V, Saul J (2001) Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 84(8):1011–1015CrossRefGoogle Scholar
  36. 36.
    Ziegler L, Hill K, Neilly L, Bennett MI, Higginson IJ, Murray SA, Stark D, Collaborative C (2011) Identifying psychological distress at key stages of the cancer illness trajectory: a systematic review of validated self-report measures. J Pain Symptom Manag 41(3):619–636CrossRefGoogle Scholar
  37. 37.
    Hong J, Tian J (2013) Sensitivity and specificity of the distress thermometer in screening for distress in long-term nasopharyngeal cancer survivors. Curr Oncol 20(6):e570CrossRefGoogle Scholar
  38. 38.
    BK R, TS M, LS S, LL EC, KL KR (2016) Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: screening cancer patients for distress, anxiety and depression. Asia Pac J Clin Oncol 12(2):e241–e249. CrossRefGoogle Scholar
  39. 39.
    Youngstrom EA (2013) A primer on receiver operating characteristic analysis and diagnostic efficiency statistics for pediatric psychology: we are ready to ROC. J Pediatr Psychol 39(2):204–221CrossRefGoogle Scholar
  40. 40.
    Bruss FT, Rüschendorf L (2010) On the perception of time. Gerontology 56(4):361–370CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of Medical OncologyUMHAT “St. Marina”VarnaBulgaria
  2. 2.Department of Propedeutics of Internal DiseasesMedical University of VarnaVarnaBulgaria

Personalised recommendations