Questions About Cancer? 1-800-4-CANCER
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Adjustment to Cancer: Anxiety and Distress (PDQ®)

Risk Factors: Prevalence and Predictors of Distress

A few studies have investigated the prevalence of distress as measured by the National Comprehensive Cancer Network Distress Thermometer (DT).[1-6] Prevalence rates in patients with cancer range from 22% to 58%. Different cutoff scores have been used, with most studies using a cutoff score of 4 or 5.

Pooled results from multiple studies suggest that approximately 40% of cancer patients report significant distress.[7] Patients with lung, pancreatic, and brain cancers seem more likely to report distress, but in general, type of cancer is only modestly associated with distress.

In regard to prevalence of distress along the clinical course, one study of 236 newly diagnosed breast cancer patients (awaiting their initial consultation with a surgical oncologist) found that 41% reported distress scores higher than 5 on the DT. In this same group of women, 11% reported symptoms suggestive of major depression, and 10% reported symptoms of posttraumatic stress.[8]

In a study of 321 women with newly diagnosed stage I to stage III breast cancer, the ability of the single-item DT to specifically predict depression—as measured by a self-report questionnaire of the nine symptoms for major depressive disorder in the fourth revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)—was investigated. Sensitivity and specificity characteristics were evaluated, and the optimal cutoff score of 7 was identified, resulting in a sensitivity of 0.81 and a specificity of 0.85 for detecting depression. Therefore, individuals scoring 7 or above should undergo a more thorough psychosocial evaluation.[9]

Regarding predictors of distress, in a large sample (N = 380) of patients with mixed cancer diagnoses, those reporting a score of 4 or higher on the DT were more likely to be women, to have poorer functional performance (self-reported Karnofsky Performance Scale), and to have reported (on the Problem List that accompanies the DT) problems with housing, dealing with children, dealing with partner, depression, fears, nervousness, sadness, worry, and 14 of 20 physical ailments.[2]

In regard to predictors of posttreatment distress, a longitudinal, observational study of 151 women with early-stage breast cancer found that physical symptoms and side effects experienced during treatment were predictive of posttreatment cancer-related distress, amounting to 6% of the total 24% of variance accounted for.[10] In addition, demographic variables associated with this posttreatment cancer-related distress included younger age, nonwhite racial status, and less formal education. Clinical variables associated with distress included having a mastectomy rather than lumpectomy, receiving hormonal treatment, and the presence of a diagnosable mental disorder at the time of recruitment into the study.


  1. Hoffman BM, Zevon MA, D'Arrigo MC, et al.: Screening for distress in cancer patients: the NCCN rapid-screening measure. Psychooncology 13 (11): 792-9, 2004. [PUBMED Abstract]
  2. Jacobsen PB, Donovan KA, Trask PC, et al.: Screening for psychologic distress in ambulatory cancer patients. Cancer 103 (7): 1494-502, 2005. [PUBMED Abstract]
  3. Akizuki N, Akechi T, Nakanishi T, et al.: Development of a brief screening interview for adjustment disorders and major depression in patients with cancer. Cancer 97 (10): 2605-13, 2003. [PUBMED Abstract]
  4. Roth AJ, Kornblith AB, Batel-Copel L, et al.: Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer 82 (10): 1904-8, 1998. [PUBMED Abstract]
  5. Ibbotson T, Maguire P, Selby P, et al.: Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 30A (1): 37-40, 1994. [PUBMED Abstract]
  6. Trask PC, Paterson A, Riba M, et al.: Assessment of psychological distress in prospective bone marrow transplant patients. Bone Marrow Transplant 29 (11): 917-25, 2002. [PUBMED Abstract]
  7. Carlson LE, Waller A, Mitchell AJ: Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol 30 (11): 1160-77, 2012. [PUBMED Abstract]
  8. Hegel MT, Moore CP, Collins ED, et al.: Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer. Cancer 107 (12): 2924-31, 2006. [PUBMED Abstract]
  9. Hegel MT, Collins ED, Kearing S, et al.: Sensitivity and specificity of the Distress Thermometer for depression in newly diagnosed breast cancer patients. Psychooncology 17 (6): 556-60, 2008. [PUBMED Abstract]
  10. Jim HS, Andrykowski MA, Munster PN, et al.: Physical symptoms/side effects during breast cancer treatment predict posttreatment distress. Ann Behav Med 34 (2): 200-8, 2007 Sep-Oct. [PUBMED Abstract]
  • Updated: February 19, 2015