Screening and management of distress are essential. The Distress thermometer (DT) is a common screening tool. However, it’s cutoff score and the accuracy properties such as sensitivity and specificity is still unclear in Chinese cancer patients.
In this cross-sectional study, DT was compared against the Hospital Anxiety and Depression Scale (HADS) in 784 heterogeneous cancer inpatients. The HADS cutoff score ≥15, ≥6, and ≥9 were used to define distress, anxiety, and depression respectively. Receiver operating characteristic (ROC) analysis was applied to determine the discriminative accuracy of DT against each scale.
When DT was compared against HADS-T, ROC showed an excellent area under the curve (AUC) of 0.903. The optimal cutoff score of 4 yielded sensitivity (SE)=89.3%, specificity (SP)=85.8%, positive predictive value (PPV)=89.9%, negative predictive value (NPV)=85.0%, screening utility (UI-)=.729, and case-finding utility (UI+)=.802. Furthermore, compared With HADS subscales, AUC=0.801 with a cutoff score 3 on DT optimally detected SE = 80.7%, SP = 64.5% PPV=89.4%, NPV=47.3%, UI-=.369, andUI + =.721 for anxiety and AUC=0.802 with a cutoff score of 4 on DT optimally detected SE = 88.3%, SP = 65.3%, PPV=66.4%, NPV=87.8%, UI-=.573 and UI + =.586 for depression respectively. DT Scores were moderately correlated with HADS-Total, HADS-Anxiety, andHADS-Depression. Female gender, low education level, advanced cancer stage, no exercise habit, suicidal ideation and months since diagnosis more than 12 were found to be associated with distress.
For Chinese patients with cancer, DT is an efficacious screening and case finding a tool for distress. Among the subscales, DT performed well in both screening and case finding for depression, however, although the case finding was good it carried a poor screening ability for anxiety.
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The author has declared no conflicts of interest.