BMJ supportive & palliative care · 2026
Distress thermometer and determinants of psychological distress in metastatic breast cancer.
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Sun Huihui, Lv Huimin, Niu Limin, Chen Shumin, Zhang Zhiqing, Yan Min
Аннотация
BACKGROUND: Metastatic breast cancer (MBC) is generally considered an incurable disease, and patients require continuous systematic treatment. Receiving the diagnosis and treatment of MBC is a distressing experience that may accelerate an episode of psychological disorder. This study examined the performance of the distress thermometer (DT) and identified the risk factors associated with psychological distress (PD).
METHODS: We assessed 337 patients diagnosed with MBC in Henan Cancer Hospital. All patients completed the electronic DT and Hospital Anxiety and Depression Scale (HADS) online. Receiver operating characteristic (ROC) analysis compared DT accuracy against HADS-Total score (HADS-T) defined PD (HADS≥15). Multivariate regression identified PD-associated factors.
RESULTS: DT average scores were significantly higher in HADS-T≥15 patients (4.27 vs 2.01, p<0.001). In ROC analysis, the DT showed strong discriminatory power relative to the HADS diagnosis of depression and anxiety, with an area under the curve of 0.76. A score of 4 represented the optimal trade-off between sensitivity (0.58) and specificity (0.85) characteristics for detecting distress. PD was associated with (unstandardised coefficient (B)=1.663, p=0.04) curative effect, and patients with poorer therapeutic effects experience more distress.
CONCLUSION: The single-item DT has been determined to be a valid tool for screening distress in patients with MBC. We recommend using a cut-off score of 4 in this population. While our analysis revealed a significant association between poor treatment response and elevated distress scores, these findings cohere with the broader clinical imperative to prioritise distress management for all cancer patients regardless of treatment outcomes.
METHODS: We assessed 337 patients diagnosed with MBC in Henan Cancer Hospital. All patients completed the electronic DT and Hospital Anxiety and Depression Scale (HADS) online. Receiver operating characteristic (ROC) analysis compared DT accuracy against HADS-Total score (HADS-T) defined PD (HADS≥15). Multivariate regression identified PD-associated factors.
RESULTS: DT average scores were significantly higher in HADS-T≥15 patients (4.27 vs 2.01, p<0.001). In ROC analysis, the DT showed strong discriminatory power relative to the HADS diagnosis of depression and anxiety, with an area under the curve of 0.76. A score of 4 represented the optimal trade-off between sensitivity (0.58) and specificity (0.85) characteristics for detecting distress. PD was associated with (unstandardised coefficient (B)=1.663, p=0.04) curative effect, and patients with poorer therapeutic effects experience more distress.
CONCLUSION: The single-item DT has been determined to be a valid tool for screening distress in patients with MBC. We recommend using a cut-off score of 4 in this population. While our analysis revealed a significant association between poor treatment response and elevated distress scores, these findings cohere with the broader clinical imperative to prioritise distress management for all cancer patients regardless of treatment outcomes.