Screening for distress in cancer patients

A multicenter, nationwide study in Italy


  • The Italian Society of Psycho-Oncology (SIPO) Distress Thermometer Study Group is indebted to all the physicians, nurses, and patients who participated in the study.

  • Coauthors of this article, as part of the Italian Society of Psycho-Oncology Distress Thermometer Study Group, are: Federica Andreis (Brescia), Valentina Belbusti (Fano), Giorgia Bellini (Faenza), Alejandra Berardi (Forlì), Simona Brovelli (Novara), Rossana De Feudis (Bari), Monia Duca (Fabriano), Leonardo Fei (Firenze), Giovanna Ferrandes (Genova), Angelo Frigerio (Bergamo), Colette Galotti (Varese), Sabina Godi (Pesaro), Monica Guaraldi (Bologna), Giovanna Mantegna (Campobasso), Sabrina Marini (Fermo), Elena Meggiolaro (Forlì), Cinzia Molieri (Bergamo), Rosanna Montanaro (Bari), Maura Muccini (Riccione, Cattolica), Maria Luisa Nadalini (Verona), Luca Ostacoli (Torino), Sara Padovani (Ferrara), Alessandra Palma (Palermo), Daniela Palmisano (Torino), Valentina Panella (Prato), Laura Pedrinelli Carrara (Senigallia), Angela Piattelli (Cosenza), Patrizia Pugliese (Roma). Marco Romeo (Urbino), Francesca Romito (Bari), Giulia Rossetti (Ferrara), Sara Serrao (Ascoli Piceno), Ilaria Strada (Lugo), Anna Verrengia (Avellino), and Cristina Wuhrer (Brescia).



Routine screening for distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on quality of life. The objective of the current study was to contribute to the Italian validation of the Distress Thermometer (DT) to determine whether the single item DT compared favorably with referent criterion measures.


In total, 1108 outpatients with cancer were recruited from 38 representative oncology centers in Italy. Each participant completed the DT and a list of 34 possible cancer-related problems (the Problem List), the Hospital Anxiety and Depression Scale (HADS), the 18-item Brief Symptom Inventory (BSI-18), and a short visual analog scale to determine the understandability of the tools.


Receiver operating characteristic analysis revealed that DT cutoff scores ≥4 and ≥5 had optimal sensitivity and specificity relative to both HADS and BSI-18 cutoff scores for general caseness and more severe psychological distress, respectively. Patients with DT scores ≥4 (cases) were more likely to be women; to have had psychological problems in the past; to report more stressful events in the last year; and to currently have more family, emotional, and physical problems related to cancer or cancer treatment. Patients indicated that the DT was easier to fill out and to understand than the HADS, but not the BSI-18.


The DT was identified as a simple and effective screening instrument for detecting distress in Italian cancer patients as a first step toward more properly referring those in need to psychosocial intervention. Cancer 2013. © 2013 American Cancer Society.