The diagnostic role of a short screening tool—the distress thermometer: a meta-analysis
- 1.2k Downloads
The Distress Thermometer (the DT) is a commonly used screening tool to detect distress in cancer patients. This meta-analysis aims to examine the diagnostic role and the optimal cut-off score of the DT compared with various different reference standards.
We searched PubMed and Embase from 1997 to September 2013 for relevant studies. After extracting data, we estimated the pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios, and constructed summary receiver operating characteristics curves to determine the optimal cut-off score.
Forty-two relevant studies and 14,808 patients were included in total. When we pooled all the results together, the DT showed a good balance between pooled sensitivity (0.81, 95 % confidence intervals (CI) 0.79–0.82) and pooled specificity (0.72, 95 % CI 0.71–0.72) at the cut-off score of 4. The value of area under the curve (AUC) is 0.8321. When the DT is compared with the HADS-Total, the cut-off score of 4 maximized the balance between the pooled sensitivity (0.82, 95 % CI 0.80–0.84) and pooled specificity (0.73, 95 % CI 0.72–0.74). The AUC is 0.8432.
This meta-analysis suggests that the DT is a valid tool to detect potential distress in cancer patients. According to our results, 4 as the optimal cut-off, is recommended. Further studies are needed to be done to examine the accuracy and optimal cut-off score in different regions globally and different cancer subtypes to guide the use of the DT for different patients.
KeywordsDistress thermometer Diagnosis Cancer patients Meta-analysis
Conflict of Interest
No financial support was received. No conflict of interest exists for any author. We have full control of all primary data and we agree to allow the journal to review our data if requested.
- 1.(2003) Distress management. Clinical practice guidelines J Natl Compr Canc Netw 1: 344–374Google Scholar
- 16.Holland JC, Andersen B, Breitbart WS, Compas B, Dudley MM, Fleishman S, Fulcher CD, Greenberg DB, Greiner CB, Handzo GF, Hoofring L, Jacobsen PB, Knight SJ, Learson K, Levy MH, Loscalzo MJ, Manne S, McAllister-Black R, Riba MB, Roper K, Valentine AD, Wagner LI, Zevon MA (2010) Distress management. J Natl Compr Cancer Netw 8:448–485Google Scholar
- 36.Chambers SK, Zajdlewicz L, Youlden DR, Holland JC, Dunn J (2013) The validity of the distress thermometer in prostate cancer populations PsychooncologyGoogle Scholar
- 37.Deng YT, Zhong WN, Jiang Y (2013) Measurement of distress and its alteration during treatment in nasopharyngeal carcinoma patients Head NeckGoogle Scholar
- 40.Grassi L, Sabato S, Rossi E, Marmai L, Biancosino B (2009) Affective syndromes and their screening in cancer patients with early and stable disease: Italian ICD-10 data and performance of the Distress Thermometer from the Southern European Psycho-Oncology Study (SEPOS). J Affect Disord 114:193–199PubMedCrossRefGoogle Scholar
- 44.Lotfi-Jam K, Gough K, Schofield P, Aranda S (2013) Profile and predictors of global distress: can the DT guide nursing practice in prostate cancer? Palliat Support Care: 1-10Google Scholar
- 45.Martinez P, Galdon MJ, Andreu Y, Ibanez E (2013) The Distress Thermometer in Spanish cancer patients: convergent validity and diagnostic accuracy Support Care CancerGoogle Scholar
- 49.Roerink SH, de Ridder M, Prins J, Huijbers A, de Wilt HJ, Marres H, Repping-Wuts H, Stikkelbroeck NM, Timmers HJ, Hermus AR, Netea-Maier RT (2013) High level of distress in long-term survivors of thyroid carcinoma: results of rapid screening using the distress thermometer. Acta Oncol 52:128–137PubMedCrossRefGoogle Scholar
- 51.Ryan DA, Gallagher P, Wright S, Cassidy EM (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. Psychooncology 21:1275–1284PubMedCrossRefGoogle Scholar