The use of the Distress Thermometer and the Hospital Anxiety and Depression Scale for screening of anxiety and depression in Italian women newly diagnosed with breast cancer



Distress is a factor that can adversely affect quality of life in breast cancer patients. A rapid and non-invasive tool to accurately detect distress is therefore important. The aims of the study were (1) to describe the women’s experiences after having received a breast cancer diagnosis and while awaiting primary surgery, in terms of anxiety and depression, (2) to evaluate the use of the Distress Thermometer (DT) in newly diagnosed breast cancer patients, and (3) to define an optimal cutoff score for the DT for this population.


This study involved 436 newly diagnosed patients in the pre-surgery phase. Consent forms and questionnaires were delivered by nurses during the pre-surgery check-ups, in the time between the 4 weeks post-diagnosis and the 2 weeks before surgery. Receiver operating characteristic analysis was used to evaluate the diagnostic accuracy of the DT compared to the Hospital Anxiety and Depression Scale (HADS) and to define an optimal cutoff score for the DT in this specific population.


The results showed that the DT is a fast, easy, and well-accepted screening tool in the Italian context of women newly diagnosed with breast cancer, performing well in relation to the HADS. The proposed cutoff score for DT screening in the clinical setting is 4 versus 5.


The DT is recommended as a first step in screening, always followed by a more detailed evaluation of psychological functioning.

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Correspondence to Daniela Acquadro Maran.

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Relevance of the manuscript

In the context of the Italian public health system, screening procedures for psychological problems are fundamental to achieve the goal of providing the best possible holistic care. At the same time, this care must be provided with the best and most efficient use of the human and economic resources available. The DT is a fast, easy, and well-accepted screening tool in the Italian context of women newly diagnosed with breast cancer, performing well in relation to the HADS. The test is recommended as a first step in the screening procedure, always followed by a more detailed evaluation of the psychological functioning of the patient.

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Civilotti, C., Acquadro Maran, D., Santagata, F. et al. The use of the Distress Thermometer and the Hospital Anxiety and Depression Scale for screening of anxiety and depression in Italian women newly diagnosed with breast cancer. Support Care Cancer 28, 4997–5004 (2020).

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  • Breast cancer
  • Distress
  • Anxiety
  • Depression