Supportive Care in Cancer

, Volume 27, Issue 11, pp 4115–4121 | Cite as

Psychosocial distress in oncology: using the distress thermometer for assessing risk classes

  • Claudia CormioEmail author
  • Francesca Caporale
  • Roberta Spatuzzi
  • Fulvia Lagattolla
  • Andrea Lisi
  • Giusi Graziano
Original Article



Cancer patients often suffer for psychological distress, which can compromise their quality of life. Our study aimed to recognize risk classes for the development of psychosocial distress.


Three hundred seventy-two adult cancer patients were assessed by the Distress Thermometer (DT) and Problem List at the National Cancer Research Centre “Giovanni Paolo II” of Bari. We also compiled a socio-medical and clinical-medical record survey ad hoc for collecting socio-demographic information and clinical variables. To examine the interplay among the different variables and distinguish internally homogeneous subgroups of patients with diverse risks of distress, the RECursive Partitioning and Amalgamation (RECPAM) technique was used.


Most of patients were female and the most frequent diagnosis was breast cancer, followed by gastro-intestinal cancer and hematological cancer. Distress was present in 43% of the sample, with a total of 156 patients with a DT > 5. The RECPAM analysis identified three distinct and homogeneous patient subgroups (RECPAM classes) with different risks of distress: diagnosis, marital status, and Eastern Cooperative Oncology Group Performance Status.


The use of the distress thermometer allows clinicians to identify patients with certain characteristics that may increase the risk of developing psychosocial distress. This evaluation can allow timely psychological intervention and improve the patient’s therapeutic program.


Cancer Distress RECPAM Risk class Distress thermometer 



We would like to acknowledge doctors Loredana D’Ambrosio and Silvia Greco for their effort in data collecting.

Compliance with ethical standards

Conflict of interest

Authors declare to have not a financial relationship with the organization that sponsored the research. Authors state to have full control of all primary data and they agree to allow the journal to review their data if requested.

Statement of human rights

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

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Zabora J, Brintzenhofeszoc K, Curbow B et al (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28.<19::AID-PON501>3.0.CO;2-6 CrossRefPubMedGoogle Scholar
  2. 2.
    Vehling S, Koch U, Ladehoff N, Schön G, Wegscheider K, Heckl U, Wels J, Mehnert A (2012) Prävalenz affektiver und Angststörungen bei Krebs: systematischer Literaturreview und Metaanalyse Prevalence of affective and anxiety disorders in cancer: systematic. Psychother Psych Med:249–258Google Scholar
  3. 3.
    Mehnert A, Vehling S, Sche K et al (2013) Prävalenz von Anpassungsstörung, Akuter und Posttraumati-scher Belastungsstörung sowie somatoformen Störungen bei Krebspatienten Prevalence of adjustment disorder, acute and posttraumatic stress disorders as well as somatoform disorders in cancer patie. Psychother Psych Med 63:466–472. CrossRefGoogle Scholar
  4. 4.
    Richardson EM, Schüz N, Sanderson K et al (2017) Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis. Psychooncology 26:724–737. CrossRefPubMedGoogle Scholar
  5. 5.
    Mitchell AJ, Vahabzadeh A, Magruder K (2011) Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research. Psychooncology 20:572–584. CrossRefPubMedGoogle Scholar
  6. 6.
    National Comprehensive Cancer Network Distress managementGoogle Scholar
  7. 7.
    Kissane D (2009) Beyond the psychotherapy and survival debate: the challenge of social disparity, depression and treatment adherence in psychosocial cancer care. Psychooncology 18:1–5. CrossRefPubMedGoogle Scholar
  8. 8.
    Bultz BD, Carlson LE (2006) Emotional distress: the sixth vital sign—future directions in cancer care. Psychooncology 15:93–95. CrossRefPubMedGoogle Scholar
  9. 9.
    Grassi L, Johansen C, Annunziata MA et al (2013) Screening for distress in cancer patients: a multicenter, nationwide study in Italy. Cancer 119:1714–1721. CrossRefPubMedGoogle Scholar
  10. 10.
    Arnaboldi P, Riva S, Vadilonga V et al (2017) Distress and psychosocial needs in patients accessing a cancer day surgery division: implications for clinical decision making. Front Psychol 7:1–6. CrossRefGoogle Scholar
  11. 11.
    Snowden A, C a W, Christie Z et al (2011) The clinical utility of the distress thermometer: a review. Br J Nurs 20:220–227. CrossRefPubMedGoogle Scholar
  12. 12.
    Petty L, Lester J (2014) Distress screening in chronic disease: essential for cancer survivors. J Adv Pract Oncol 5:107–114PubMedPubMedCentralGoogle Scholar
  13. 13.
    National Comprehensive Cancer Network (1999) NCCN practice guidelines for the management of psychosocial distress. Oncology (Williston Park) 13:113–147Google Scholar
  14. 14.
    Roth A, Kornblith A, Batel-Copel L et al (1998) Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer 82:1904–1908CrossRefGoogle Scholar
  15. 15.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: distress management version 1. 2013Google Scholar
  16. 16.
    Jacobsen PB, Donovan KA, Trask PC et al (2005) Screening for psychologic distress in ambulatory cancer patients: a multicenter evaluation of the distress thermometer. Cancer 103:1494–1502. CrossRefPubMedGoogle Scholar
  17. 17.
    Donovan KA, Grassi L, McGinty HL, Jacobsen PB (2014) Validation of the distress thermometer worldwide: state of the science. Psychooncology 23:241–250. CrossRefPubMedGoogle Scholar
  18. 18.
    Bulli F, Miccinesi G, Maruelli A et al (2009) The measure of psychological distress in cancer patients: the use of distress thermometer in the oncological rehabilitation center of Florence. Support Care Cancer 17:771–779. CrossRefPubMedGoogle Scholar
  19. 19.
    Dabrowski M, Boucher K, Ward JH et al (2007) Clinical experience with the NCCN distress thermometer in breast cancer patients. J Natl Compr Canc Netw 5:104–111CrossRefGoogle Scholar
  20. 20.
    Werner A, Stenner C, Schüz J (2012) Patient versus clinician symptom reporting: how accurate is the detection of distress in the oncologic after-care? Psychooncology 21:818–826. CrossRefPubMedGoogle Scholar
  21. 21.
    Carlson LE, Bultz BD (2003) Benefits of psychosocial oncology care: improved quality of life and medical cost offset. Health Qual Life Outcomes 1:8. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefGoogle Scholar
  23. 23.
    Ciampi A, Hogg S, McKinney S, Thiffault T (1988) RECPAM: a computer program for recursive partition and amalgamation for censored survival data and other situations frequently occurring in biostatistics. I. Methods and program features. Comput Methods Prog Biomed 26:239–256CrossRefGoogle Scholar
  24. 24.
    Ciampi A (1992) Constructing prediction trees from data: the RECPAM approach. In: Prague 1991 summer Sch. Comput. Asp. Model choice. Heidelberg: Physica-Verlag, Prague, pp 165–178Google Scholar
  25. 25.
    Bellè M, Muzzatti B, Tomas M, Gherlinzoni F (2016) Psychological screening of onco-hematologic inpatients: distress thermometer administration. Tumori 102:178–183. CrossRefPubMedGoogle Scholar
  26. 26.
    Meggiolaro E, Berardi MA, Andritsch E et al (2015) Cancer patients’ emotional distress, coping styles and perception of doctor-patient interaction in European cancer settings. Palliat Support Care:1–8. CrossRefGoogle Scholar
  27. 27.
    Mehnert A, Hartung TJ, Friedrich M et al (2017) One in two cancer patients is significantly distressed: prevalence and indicators of distress. Psychooncology. CrossRefGoogle Scholar
  28. 28.
    Linden W, Vodermaier A, MacKenzie R, Greig D (2012) Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord 141:343–351. CrossRefPubMedGoogle Scholar
  29. 29.
    Kurz K, Reißig A, Strauß B, Rosendahl J (2014) Geschlechtsunterschiede in der psychischen Belastung von Patienten mit Lungenkarzinom und deren Partnern. PPmP - Psychother · Psychosom · Medizinische Psychol 64:431–438. CrossRefGoogle Scholar
  30. 30.
    Goldzweig G, Andritsch E, Hubert A, Walach N, Perry S, Brenner B, Baider L (2009) How relevant is marital status and gender variables in coping with colorectal cancer? A sample of middle-aged and older cancer survivors. Psychooncology 18:866–874. CrossRefPubMedGoogle Scholar
  31. 31.
    Stanton AL, Danoff-Burg S, Cameron CL, Bishop M, Collins CA, Kirk SB, Sworowski LA, Twillman R (2000) Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. J Consult Clin Psychol 68:875–882CrossRefGoogle Scholar
  32. 32.
    Iacorossi L, Gambalunga F, Fabi A et al (2016) Adherence to hormone therapy in women with breast cancer: a quantitative study. Prof Inferm 69:113–121PubMedGoogle Scholar
  33. 33.
    Berhili S, Kadiri S, Bouziane A et al (2017) Associated factors with psychological distress in Moroccan breast cancer patients: a cross-sectional study. Breast 31:26–33. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Psycho-Oncology UnitIRCCS Istituto Tumori “Giovanni Paolo II”BariItaly
  2. 2.Palliative Care Unit, San Carlo Hospital, Via Potito PetronePotenzaItaly

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