The validity of the distress thermometer in patients with musculoskeletal tumors.

ABSTRACT

Background: Visits to an outpatient cancer clinic represent a challenging situation for patients, which can trigger anxiety and helplessness in those affected. It is important to identify patients with high psychological distress as early as possible in order to provide them with supportive psychological interventions. The aim of this study was to validate the Distress Thermometer (DT), a widely used screening for distress, in a cohort of patients with musculoskeletal tumors and to explore associations between distress, treatment satisfaction and health literacy. Methods: All patients presenting to a University outpatient clinic for musculoskeletal cancers were asked to complete a set of questionnaires including the DT), the Hospital Anxiety and Depression Scale (HADS) as a comparison scale, the Patient Satisfaction with Comprehensive Cancer Care (SCCC) and European Health Literacy Survey Questionnaire (HLS-EU-Q16).To assess the sensitivity and specificity of the DT in a cohort of patients with musculoskeletal tumors, we compare the performance of the DT in relation to an established screener for anxiety and depression using receiver operating characteristics (ROC) analyses. Results: A total of 120 patients (age 58 ± 18, 51% female) were analyzed. Patients reported a mean DT of 5.0 (SD 2.3, range, 0 to 10). Eighty-six patients (71.7 %) had a DT score ≥ 5 indicating moderate or severe psychological distress.The mean total HADS score (scale 0 to42 points) was 11.7 (SD 7.6, range, 0 to 32) with a HADS score of ≥ 15 in 29.2% of patients. The DT correlated moderately with anxiety and depression (HADS total r = 0.48, p < 0.001), while the correlation with depression (HADS-D, r = 0.47, p < 0.001) was stronger than with anxiety (HADS-A, r = 0.38, p < 0.001).For a DT score ≥ 5, ROC analysis yielded a sensitivity of 71.4% and a specificity of 75.3% for detecting moderate or severe psychological distress (HADS ≥ 15, AUC 0.782).The REPERES-G, collected from a subgroup (n = 49), showed high treatment satisfaction with a median score of 132 (min 90, max 163). Especially the "satisfaction with medical aspects of treatment" (REPERES-G medical aspects) showed a moderate correlation with the DT (r = 0.51, p < 0.001) a strong correlation with anxiety and depression (HADS total, r = 0.69, p < 0.001). Conclusion: About three in four patients with musculoskeletal tumors have relevant psychological distress. A visual analogue scale can only be a rough guide for identifying patients in need of psychological support, with a sensitivity of 71.4 % and a specificity of 75.3 %. A strong relationship between patient and care team was associated with lower patient psychological distress.Consequently, screening tools cannot replace detailed discussion and personal contact, especially in the treatment of malignant diseases.