Vital Signs: Recognizing and Managing Distress

Recognizing & managing distress can lead to better outcomes.

The recognition that distress affects care has led to a push for screening patients while they are in the hospital or doctor’s office (immediately after diagnosis and at times during their treatment). However, there’s no single unified measure of distress—in fact, more than 30 different sets of questions and criteria are in use—and different methods have different pros and cons. For example, filling out a short questionnaire may be quick and easy for patients, and it may accurately identify patients in distress, but it may also misidentify patients who are not. The best screening tool is one that identifies patients who are in distress and rules out those patients who are not—avoiding not only misdiagnosis but also overdiagnosis.  

In 2009, a team of researchers based in Canada reviewed all the methods of screening for distress in the Journal of the National Cancer Institute. Some screening tests are a matter of one or two questions ("Are you depressed?" or "Have you lost interest?"). Another quick, widely used test is called the NCCN Distress Thermometer. Yet after reviewing the evidence for short screening tests, the study’s authors recommended a 20-item, self-reported scale from the Center for Epidemiological Studies. For that test, a person reads a list of criteria, such as "My sleep was restless" or "I talked less than usual," and indicates how many days in the past week these situations occurred.

The nonprofit Cancer Support Community developed a 25-item Web-based questionnaire, available to patients who are close to one of the 48 CSC sites nationwide. Users who visit a CSC site to complete the screening and referral program, which takes less than 10 minutes, receive a personalized plan with information about their distress level and available support resources, while their healthcare provider receives a summary of the results with alerts for follow-up care (visit for details).

Those who are not close to a CSC location can visit the American Cancer Society website ( and enter "measure my distress" in the search box. Results include a self-administered test to determine distress level and recommendations for what to do if distress is high.

Valerie Mueller, CSC Health Care Account director, says those who want to speak to a counselor can call the CSC hotline (888-793-9355) from 9 a.m. to 8 p.m. EST Monday through Friday.

Regardless of the method used, one advantage to widespread distress screening, in addition to catching patients before they slip through the cracks, is that it could help remove an unfortunate stigma associated with mental health. "When screening is routine for everybody, there is less stigma associated with it," says Elizabeth Rohan, a sociologist and a health scientist in the division of Cancer Prevention and Control at the U.S. Centers for Disease Control and Prevention in Atlanta. "Plus, if people are getting screened regularly, they are getting treatment sooner."

When screening is routine for everybody, there is less stigma associated with it. Plus, if people are getting screened regularly, they are getting treatment sooner.

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