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Assessment of emotional distress in palliative care: Edmonton Symptom Assessment System-revised (ESAS-r) vs Distress Thermometer

Published online by Cambridge University Press:  27 October 2023

Leticia Ascencio Huertas Open the ORCID record for Leticia Ascencio Huertas [Opens in a new window] ,
Silvia Rosa Allende Pérez Open the ORCID record for Silvia Rosa Allende Pérez [Opens in a new window]  and
Adriana Peña Nieves Open the ORCID record for Adriana Peña Nieves [Opens in a new window]
Leticia Ascencio Huertas*
Affiliation:
Unit of Palliative Care, Instituto Nacional de Cancerología, Tlalpan, Ciudad de México, México
Silvia Rosa Allende Pérez
Affiliation:
Unit of Palliative Care, Instituto Nacional de Cancerología, Tlalpan, Ciudad de México, México
Adriana Peña Nieves
Affiliation:
Unit of Palliative Care, Instituto Nacional de Cancerología, Tlalpan, Ciudad de México, México
*
Corresponding author: Leticia Ascencio Huertas; Email: lascencioh@incan.edu.mx; leash71@yahoo.com.mx
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Abstract

Objectives

To evaluate the sensitivity and specificity of the Distress Thermometer (DT) as a screening tool for emotional distress in oncological palliative care patients and to compare the DT with the Edmonton Symptom Assessment System-revised (ESAS-r) and the gold standard to determine the most appropriate assessment method in palliative psychological care.

Methods

Data were collected from psychological screening tests (ESAS-r and DT), and clinical interviews (gold standard) were conducted by a clinical psychologist specialist in palliative oncology from January 2021 to January 2022 in an oncology palliative care service.

Results

The sample consisted of 356 first-time patients with a diagnosis of advanced cancer in palliative care. The most frequently reported oncological diagnoses were gastrointestinal tract (49.3%) and breast (18.3%). Most patients were female (n = 206; 57.9%), 60.4% were married/with a partner, 55.4% had between 6 and 9 years of schooling, and a median age of 57 (range, 46–65) years. The cutoff of the DT was 5, with a sensitivity of 75.88% and specificity of 54.3%. Emotional problems (sadness and nervousness) had a greater area under the curve (AUC) when measured using the DT than the ESAS-r; however, only in the case of the comparative sadness and discouragement was the difference between the AUC marginally significant.

Significance of results

The use of the DT as a screening tool in oncological palliative care is more effective in the evaluation of psychological needs than the ESAS-r. The DT, in addition to evaluation by an expert psychologist, allows for a more comprehensive identification of signs and symptoms to yield an accurate mental health diagnosis based on the International Classification of Diseases-11th Revision and/or Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition.

Keywords

Emotional distresspalliative careadvanced cancerDistress ThermometerESAS-r
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 2 , April 2024 , pp. 258 - 264
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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References

Aboshaiqah, A, Al-Saedi, TSB, Abu-Al-Ruyhaylah, MMM, et al. (2016) Quality of life and satisfaction with care among palliative cancer patients in Saudi Arabia. Palliative & Supportive Care 14(6), 621–627. doi:10.1017/S1478951516000432CrossRefGoogle ScholarPubMed
Ascencio-Huertas, L, Allende-Pérez, SR and Pastrana, T (2021) Associated factors of distress in patients with advanced cancer: A retrospective study. Palliative & Supportive Care 19(4), 447–456. doi:10.1017/S1478951520001066CrossRefGoogle ScholarPubMed
Basch, E, Deal, AM, Kris, MG, et al. (2016) Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. Journal of Clinical Oncology 34(6), 557–565. doi:10.1200/JCO.2015.63.0830CrossRefGoogle ScholarPubMed
Bruera, E, Kuehn, N, Miller, MJ, et al. (1991) The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care 7(2), 6–9. doi:10.1177/082585979100700202CrossRefGoogle ScholarPubMed
Carvajal, A, Centeno, C, Watson, R, et al. (2011) A comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients. European Journal of Cancer 47(12), 1863–1872. doi:10.1016/j.ejca.2011.03.027CrossRefGoogle ScholarPubMed
Chang, VT, Hwang, SS and Feuerman, M (2000) Validation of the Edmonton symptom assessment scale. Cancer 88(9), 2164–2171. doi:10.1002/(sici)1097-0142(20000501)88:9<2164::aid-cncr24>3.0.co;2-53.0.CO;2-5>CrossRefGoogle ScholarPubMed
Cutillo, A, O’Hea, E, Person, S, et al. (2017) NCCN Distress Thermometer: Cut off points and clinical utility. Oncology Nursing Forum 44(3), 329–336. doi:10.1188/17.ONF.329-336CrossRefGoogle Scholar
Deshields, T and Asvat, Y (2023) The case for accelerating integrated mental health care in the cancer setting. JCO Oncology Practice 19(5), 231–233. doi:10.1200/OP.22.00840CrossRefGoogle ScholarPubMed
Deshields, TL, Potter, P, Olsen, S, et al. (2014) The persistence of symptom burden: Symptom experience and quality of life of cancer patients across one year. Supportive Care in Cancer 22(4), 1089–1096. doi:10.1007/s00520-013-2049-3CrossRefGoogle ScholarPubMed
Donovan, KA, Grassi, L, McGinty, HL, et al. (2013) Validation of the Distress Thermometer worldwide: State of the science. Psycho-Oncology 23(3), 241–250. doi:10.1002/pon.3430CrossRefGoogle ScholarPubMed
Feldstain, A, Tomei, C, Bélanger, M, et al. (2014) Screening for distress in patients with cancer: Methodologic considerations. Current Oncology 21(2), 330–333. doi:10.3747/co.21.1794CrossRefGoogle ScholarPubMed
Ferrell, BR, Temel, JS, Temin, S, et al. (2017) Integration of palliative care into standard oncology care: ASCO clinical practice guideline update summary. Journal of Oncology Practice 13(2), 119–121. doi:10.1200/JOP.2016.017897CrossRefGoogle ScholarPubMed
Graham-Wisener, L, Dempster, M, Sadler, A, et al. (2021) Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting. Palliative Medicine 35(1), 120–129. doi:10.1177/0269216320954339CrossRefGoogle Scholar
Guan, B, Wang, K, Shao, Y, et al. (2019) The use of distress thermometer in advanced cancer in patients with pain. Psycho-Oncology 28(5), 1004–1010. doi:10.1002/pon.5032CrossRefGoogle ScholarPubMed
Hamer, M, Chida, Y and Molloy, G (2009) Psychological distress and cancer mortality. Journal of Psychosomatic Research 66(3), 255–258. doi:10.1016/j.jpsychores.2008.11.002CrossRefGoogle ScholarPubMed
Hart, NH, Crawford-Williams, F, Crichton, M, et al. (2022) Unmet supportive care needs of people with advanced cancer and their caregivers: A systematic scoping review. Critical Reviews in Oncology/Hematology 176, . doi:10.1016/j.critrevonc.2022.103728CrossRefGoogle ScholarPubMed
Holland, JC, Andersen, B, Breitbart, WS, et al. (2013) Distress management. Journal of the National Comprehensive Cancer Network 11(2), 190–209. doi:10.6004/jnccn.2013.0027CrossRefGoogle ScholarPubMed
Hui, D and Bruera, E (2017) The Edmonton symptom assessment system 25 years later: Past, present, and future developments. Journal of Pain and Symptom Management 53, 630–643. doi: 10.1016/j.jpainsymman.2016.10.370CrossRefGoogle ScholarPubMed
Hwang, KH, Cho, OH and Yoo, YS (2016) Symptom clusters of ovarian cancer patients undergoing chemotherapy, and their emotional status and quality of life. European Journal of Oncology Nursing 21, 215–222. doi:10.1016/j.ejon.2015.10.007CrossRefGoogle ScholarPubMed
Kaasa, S, Loge, JH, Aapro, M, et al. (2018) Integration of oncology and palliative care: A Lancet Oncology Commission. The Lancet Oncology 19(11), e588–e653. doi:10.1016/S1470-2045(18)30415-7CrossRefGoogle ScholarPubMed
Kilbourn, KM, Bargai, N, Durning, PE, et al. (2011) Validity of the Psycho-Oncology Screening Tool (POST). Journal of Psychosocial Oncology 29(5), 475–498. doi:10.1080/07347332.2011.599359CrossRefGoogle ScholarPubMed
Koesel, N, Tocchi, C, Burke, L, et al. (2019) Symptom distress: Implementation of palliative care guidelines to improve pain, fatigue, and anxiety in patients with advanced cancer. Clinical Journal of Oncology Nursing 23(2), 149–155. doi:10.1188/19.CJON.149-155Google ScholarPubMed
López-Roig, S, Terol, MC, Pastor, MA, et al. (2000) Ansiedad y depresión. Validación de la escala HAD en pacientes oncológicos. Revista de Psicología de la Salud 12(2), 127–155. doi:10.21134/pssa.v12i2.787Google Scholar
Martínez-López, P, Conchado-Peiró, A, Andreu-Vaillo, Y, et al. (2019) Psychometric properties of the Brief Symptom Inventory-18 in a heterogeneous sample of adult cancer patients. Revista Latinoamericana de Psicología 51(1), 1–8. doi:10.14349/rlp.2019.v51.n1.1CrossRefGoogle Scholar
Ma, X, Zhang, J, Zhong, W, et al. (2014) The diagnostic role of a short screening tool–the distress thermometer: A meta-analysis. Supportive Care in Cancer 22(7), 1741–1755. doi:10.1007/s00520-014-2143-1CrossRefGoogle Scholar
Mercadante, S, Adile, C, Ferrera, P, et al. (2019) Symptom hyper-expression in advanced cancer patients with anxiety and depression admitted to an acute supportive/palliative care unit. Supportive Care in Cancer 27(8), 3081–3088. doi:10.1007/s00520-018-4624-0CrossRefGoogle Scholar
Mitchell, AJ (2010) Short screening tools for cancer-related distress: A review and diagnostic validity meta-analysis. Journal of the National Comprehensive Cancer Network 8(4), 487–494. doi:10.6004/jnccn.2010.0035CrossRefGoogle ScholarPubMed
National Comprehensive Cancer Network (NCCN) (2020) Clinical Practice Guidelines in Oncology: Distress management. v2.2020. https://www.nccn.org/patients/guidelines/content/PDF/distress-patient.pdf (accessed 3 November 2020).Google Scholar
National Comprehensive Cancer Network (NCCN) (2023a) Distress thermometer tool translations. https://www.nccn.org/global/what-we-do/distress-thermometer-tool-translations (accessed 29 May 2023).Google Scholar
National Comprehensive Cancer Network (NCCN) (2023b) NCCN clinical practice guidelines in oncology: Distress management. Version 2023. https://www.nccn.org/professionals/physician_gls/pdf/distress.pdf (accessed 29 May 2023).Google Scholar
Páez, D, Fernández, I and Mayordomo, S (2000) Alexithymia and culture. In Páez, D and Casullo, M (eds), Cultura Y Alexitimia. Buenos Aires: Paidós, 51–71.Google Scholar
Parry, C, Padgett, LS and Zebrack, B (2012) Now what? Toward an integrated research and practice agenda in distress screening. Journal of Psychosocial Oncology 30(6), 715–727. doi:10.1080/07347332.2012.721486CrossRefGoogle ScholarPubMed
Pirl, WF, Fann, JR, Greer, JA, et al. (2014) Recommendations for the implementation of distress screening programs in cancer centers: Report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force. Cancer 120(19), 2946–2954. doi:10.1002/cncr.28750CrossRefGoogle ScholarPubMed
Rauenzahn, SL, Schmidt, S, Aduba, IO, et al. (2017) Integrating palliative care services in ambulatory oncology: An application of the Edmonton symptom assessment system. Journal of Oncology Practice 13(4), e401–e407. doi:10.1200/JOP.2016.019372CrossRefGoogle ScholarPubMed
Riba, MB, Donovan, KA, Andersen, B, et al. (2019) Distress management, version 3.2019, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network 17(10), 1229–1249. doi:10.6004/jnccn.2019.0048CrossRefGoogle ScholarPubMed
Rodríguez García, PL and Rodríguez Pupo, L (1999) Principios técnicos para realizar la anamnesis en el paciente adulto. Revista Cubana de Medicina General Integral 15(4), 409–414.Google Scholar
Roth, AJ, Kornblith, AB, Batel-Copel, L, et al. (1998) Rapid screening for psychologic distress in men with prostate carcinoma. Cancer 82(10), 1904–1908. doi:10.1002/(SICI)1097-0142(19980515)82:10%3C1904::AID-CNCR13%3E3.0.CO;2-X3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Ryan, DA, Gallagher, P, Wright, S, et al. (2012) Sensitivity and specificity of the Distress Thermometer and a two-item depression screen (Patient Health Questionnaire-2) with a ‘help’question for psychological distress and psychiatric morbidity in patients with advanced cancer. Psycho-Oncology 21(12), 1275–1284. doi:10.1002/pon.2042CrossRefGoogle Scholar
Sanchez-Aragon, R and Diaz-Loving, R (2009) Measuring rules and cultural precepts of emotional expression in Mexico. UniveRsitas Psychologica 8(3), 793–805.Google Scholar
Smith, J, Berman, S, Dimick, J, et al. (2017) Distress screening and management in an outpatient VA Cancer Clinic: A pilot project involving ambulatory patients across the disease trajectory. Federal Practitioner 34(1), 43S–50S.Google Scholar
Stark, L, Tofthagen, C, Visovsky, C, et al. (2012) The symptom experience of patients with cancer. Journal of Hospice and Palliative Nursing 14(1), 61–70. doi:10.1097/NJH.0b013e318236de5cCrossRefGoogle ScholarPubMed
Sun, H, Thapa, S, Wang, B, et al. (2021) A systematic review and meta-analysis of the distress thermometer for screening distress in Asian Patients with cancer. Journal of Clinical Psychology in Medical Settings 28(2), 212–220. doi:10.1007/s10880-020-09705-9CrossRefGoogle ScholarPubMed
Thalén-Lindström, AM, Glimelius, BG and Johansson, BB (2016) Identification of distress in oncology patients. Cancer Nursing 39(2), E31–E39. doi:10.1097/NCC.0000000000000267CrossRefGoogle ScholarPubMed
Thekkumpurath, P, Venkateswaran, C, Kumar, M, et al. (2009) Screening for psychological distress in palliative care: Performance of touch screen questionnaires compared with semistructured psychiatric interview. Journal of Pain and Symptom Management 38(4), 597–605. doi:10.1016/j.jpainsymman.2009.01.004CrossRefGoogle ScholarPubMed
Ullrich, A, Ascherfeld, L, Marx, G, et al. (2017) Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliative Care 16(1), . doi:10.1186/s12904-017-0206-zCrossRefGoogle ScholarPubMed
Vehling, S, Kissane, DW, Lo, C, et al. (2017) The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer 123(17), 3394–3401. doi:10.1002/cncr.30749CrossRefGoogle ScholarPubMed
Wagner, LI, Spiegel, D and Pearman, T (2013) Using the science of psychosocial care to implement the new American College of Surgeons Commission on Cancer distress screening standard. Journal of the National Comprehensive Cancer Network 11(2), 214–221. doi:10.6004/jnccn.2013.0028CrossRefGoogle ScholarPubMed
Wüller, J, Küttner, S, Foldenauer, AC, et al. (2017) Accuracy of the distress thermometer for home care patients with palliative care needs in Germany. Palliative & Supportive Care 15(3), 288–294. doi:10.1017/S1478951516000699CrossRefGoogle ScholarPubMed
Zabora, JR and Macmurray, L (2012) The history of psychosocial screening among cancer patients. Journal of Psychosocial Oncology 30(6), 625–635. doi:10.1080/07347332.2012.721491CrossRefGoogle ScholarPubMed