Emotional distress in cancer: screening policy, clinical limitations and educational needs

Several studies have shown that 30–40% of cancer patients present psychosocial disorders according to the DSM-IV and WHO ICD-10 disease classification systems and a further 20-25% suffer from psychosocial conditions deserving medical attention (e.g., health anxiety, demoralisation). In order to increase the likelihood that cancer patients with psychosocial distress can be detected and offered opportunity to be helped, guidelines and psychological instruments such as the NCCN Clinical Practice Guidelines in Oncology on Distress Management and the Distress Thermometer (DT) have been developed and applied in cancer settings. A cutoff score of 4–5 on the DT has been repeatedly shown to optimise sensitivity and specificity in identifying “cases” both among cancer patients and their family members. However, clinical limitations have been raised regarding the DT. The tool can benefit from changes increasing its capacity to capture different psychological dimensions, Furthermore, the policy of screening for emotional distress in cancer patients is only the first step, and it may prove to no avail if not followed by more specific psychosocial oncology programmes aimed at improving referral and adherence to referral of cancer patients with high levels of emotional distress.