Skip to main content

Advertisement

SpringerLink
Log in

Quantifying Psychological Distress among Cancer Patients in Interventions and Scales: A Systematic Review

  • Cancer Pain (D Marcus, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

The management of cancer-related psychological distress has been addressed in numerous studies, which have examined both the development of interventions to alleviate psychological distress as well as scales for evaluating their efficacy. In this systematic review, we examine results from randomized controlled trials (RCTs) on the relative effectiveness of interventions in reducing cancer-related psychological distress and the scales employed to measure this distress. An electronic database search for RCTs of psychological interventions in cancer patients from October 2008 to July 2013 was conducted using PubMed, MEDLINE, and CINAHL. Data was independently extracted and assessed by two researchers. Nineteen RCTs on interventions for psychological distress were identified and analyzed, among which eight studies reported that the interventions had a positive effect and improved the symptoms of psychological distress, and in which seven main instruments were used to measure psychological distress. The most frequently employed interventions were exercise training, cognitive behavioral therapy, and complementary therapy, followed by meeting with a psychologist and a combination of keeping a written journal and peer counseling. The three most frequently employed scales were the Profile of Mood States-Short Form (POMS-SF), Distress Thermometer (DT), and Hospital Anxiety and Depression (HADS). The majority of cancer patients experience considerable psychological and emotional distress at some time during the course of the disease. Reports have shown that interventions such as exercise training, cognitive behavioral therapy, and complementary therapy can assist oncology personnel in alleviating this distress. Future studies should consider optimizing such interventions. The POMS-SF scale, which has frequently been employed to measure the effects of psychological distress, could be incorporated into elements of screening programs for measuring unfulfilled needs, desire for assistance, clinical response, and longitudinal outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of outstanding importance

  1. Bidstrup PE, Johansen C, Mitchell AJ. Screening for cancer-related distress: Summary of evidence from tools to programmes. Acta Oncol. 2011;50:194–204.

    Article  PubMed  Google Scholar 

  2. Mosher CE, DuHamel KN. An examination of distress, sleep, and fatigue in metastatic breast cancer patients. Psychooncology. 2012;21:100–7. doi:10.1002/pon.1873.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Suzuki N, Ninomiya M, Maruta S, Hosonuma S, Nishigaya Y, Kobayashi Y, et al. Psychological characteristics of Japanese gynecologic cancer patients after learning the diagnosis according to the hospital anxiety and depression scale. J Obstet Gynaecol Res. 2011;37:800–8. doi:10.1111/j.1447-0756.2010.01437.x.

    Article  PubMed  Google Scholar 

  4. Ugalde A, Aranda S, Krishnasamy M, Ball D, Schofield P. Unmet needs and distress in people with inoperable lung cancer at the commencement of treatment. Support Care Cancer. 2012;20:419–23. doi:10.1007/s00520-011-1296-4.

    Article  PubMed  Google Scholar 

  5. Vahdaninia M, Omidvari S, Montazeri A. What do predict anxiety and depression in breast cancer patients? A follow-up study. Soc Psychiatry Psychiatr Epidemiol. 2010;45:355–61. doi:10.1007/s00127-009-0068-72010.

    Article  PubMed  Google Scholar 

  6. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10:19–28.

    Article  CAS  PubMed  Google Scholar 

  7. Carlson LE, Groff SL, Maciejewski O, Bultz BD. Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol. 2010;28:4884–91. doi:10.1200/JCO.2009.27.3698.

    Article  PubMed  Google Scholar 

  8. Geller MA, Downs LS, Judson PL, Ghebre R, Argenta PA, Carson LF, et al. Learning about ovarian cancer at the time of diagnosis: video versus usual care. Gynecol Oncol. 2010;119(2):370–5. doi:10.1016/j.ygyno.2010.06.032.

    Article  PubMed  Google Scholar 

  9. Head BA, Schapmire TJ, Keeney CE, Deck SM, Studts JL, Hermann CP, et al. Use of the Distress Thermometer to discern clinically relevant quality of life differences in women with breast cancer. Qual Life Res. 2012;21:215–23. doi:10.1007/s11136-011-9934-3.

    Article  PubMed  Google Scholar 

  10. Cappiello M, Cunningham RS, Knobf MT, Erdos D. Breast cancer survivors: Information and support after treatment. Clin Nurs Res. 2007;16:278–93.

    Article  PubMed  Google Scholar 

  11. Fawzy FI, Fawzy NW, Arndt LA, Pasnau RO. Critical review of psychosocial interventions in cancer care. Arch Gen Psychiatry. 1995;52:100–13.

    Article  CAS  PubMed  Google Scholar 

  12. Nekolaichuk CL, Cumming C, Turner J, Yushchyshyn A, Sela R. Referral patterns and psychosocial distress in cancer patients accessing a psycho-oncology counseling service. Psycho-Oncology. 2011;20:326–32. doi:10.1002/pon.1765.

    Article  PubMed  Google Scholar 

  13. Bultz B, Holland JC. Emotional distress in patients with cancer: The sixth vital sign. Community Oncol. 2006;3:311–14.

    Article  Google Scholar 

  14. Madden J. The problem of distress in patients with cancer: More effective assessment. Clin J Oncol Nurs. 2006;10:615–19.

    Article  PubMed  Google Scholar 

  15. Little M, Jordens CFC, Paul K, Montgomery K, Philipson B. Liminality: A major category of the experience of cancer illness. Soc Sci Med. 1998;47:1485–94.

    Article  CAS  PubMed  Google Scholar 

  16. Mitchell AJ, Kaar S, Coggan C, Herdman J. Acceptability of common screening methods used to detect distress and related mood disorders-preferences of cancer specialists and non-specialists. Psychooncology. 2008;17:226–36.

    Article  PubMed  Google Scholar 

  17. Aguado Loi CX, Taylor TR, McMillan S, Gross-King M, Xu P, Shoss MK, et al. Use and helpfulness of self-administered stress management therapy in patients undergoing cancer chemotherapy in community clinical settings. J Psychosoc Oncol. 2012;30:57–80. doi:10.1080/07347332.2011.633981.

    Article  PubMed  Google Scholar 

  18. Rottmann N, Dalton SO, Bidstrup PE, Würtzen H, Høybye MT, Ross L, et al. No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial. Psychooncology. 2012;21:505–14. doi:10.1002/pon.1924.

    Article  PubMed  Google Scholar 

  19. Serfaty M, Wilkinson S, Freeman C, Mannix K, King M. The ToT study: helping with Touch or Talk (ToT): A pilot randomised controlled trial to examine the clinical effectiveness of aromatherapy massage versus cognitive behaviour therapy for emotional distress in patients in cancer/palliative care. Psychooncology. 2012;21:563–9. doi:10.1002/pon.1921.

    Article  CAS  PubMed  Google Scholar 

  20. Porter LS, Keefe FJ, Baucom DH, Hurwitz H, Moser B, Patterson E, et al. Partner-assisted emotional disclosure for patients with gastrointestinal cancer: results from a randomized controlled trial. Cancer. 2009;115(18 Suppl):4326–38. doi:10.1002/cncr.24578.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Porter LS, Keefe FJ, Baucom DH, Hurwitz H, Moser B, Patterson E, et al. Partner-assisted emotional disclosure for patients with GI cancer: 8-week follow-up and processes associated with change. Support Care Cancer. 2012;20:1755–62. doi:10.1007/s00520-011-1272-z.

    Article  PubMed  Google Scholar 

  22. Powell CB, Kneier A, Chen LM, Rubin M, Kronewetter C, Levine E. A randomized study of the effectiveness of a brief psychosocial intervention for women attending a gynecologic cancer clinic. Gynecol Oncol. 2008;111:137–43. doi:10.1016/j.ygyno.2008.06.024.

    Article  PubMed  Google Scholar 

  23. David N, Schlenker P, Prudlo U, Larbig W. Internet-based program for coping with cancer: A randomized controlled trial with hematologic cancer patients. Psycho-Oncology. 2013;22:1064–72.

    Article  CAS  PubMed  Google Scholar 

  24. Schover LR, Rhodes MM, Baum G, Adams JH, Jenkins R, Lewis P, et al. Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT): A peer counseling program to improve reproductive health among African American breast cancer survivors. Cancer. 2011;117(21):4983–92. doi:10.1002/cncr.26139.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Smith MY, DuHamel KN, Egert J, Winkel G. Impact of a brief intervention on patient communication and barriers to pain management: results from a randomized controlled trial. Patient Educ Couns. 2010;81:79–86. doi:10.1016/j.pec.2009.11.021.

    Article  PubMed  Google Scholar 

  26. Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, et al. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther. 2009;8:37–46. Various components and types of yoga have shown their beneficial effects. Yoga could contribute to reducing distressful symptoms, improving sleep, mood and quality of life for early-stage breast cancer patients and patients undergoing adjuvant radiotherapy.

    Article  CAS  PubMed  Google Scholar 

  27. Juarez G, Hurria A, Uman G, Ferrell B. Impact of a bilingual education intervention on the quality of life of Latina breast cancer survivors. Oncol Nurs Forum. 2013;40:E50–60. doi:10.1188/13.ONF.E50-E60.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Quintard B, Lakdja F. Assessing the effect of beauty treatments on psychological distress, body image, and coping: a longitudinal study of patients undergoing surgical procedures for breast cancer. Psychooncology. 2008;17:1032–8. doi:10.1002/pon.1321.

    Article  PubMed  Google Scholar 

  29. Yang CY, Tsai JC, Huang YC, Lin CC. Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy. J Adv Nurs. 2011;67:158–68. doi:10.1111/j.1365-2648.2010.05492.x. Although adjuvant combination chemotherapy for the early-stage cancer patient improves survival rate, it may cause unfavorable effects. The 12-week home-based working program significantly lowered such symptoms and psychological distress in the experimental group compared to those in the control group. Moderate-intensity exercise should be incorporated into care for breast cancer patients undergoing chemotherapy.

    Article  PubMed  Google Scholar 

  30. Henry M, Cohen SR, Lee V, Sauthier P, Provencher D, Drouin P, et al. The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study. Psychooncology. 2010;19:1340–7.

    Article  PubMed  Google Scholar 

  31. Manne SL, Kissane DW, Nelson CJ, Mulhall JP, Winkel G, Zaider T. Intimacy-enhancing psychological intervention for men diagnosed with prostate cancer and their partners: a pilot study. J Sex Med. 2011;8:1197–209. doi:10.1111/j.1743-6109.2010.02163.x.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Carmack CL, Basen-Engquist K, Yuan Y, Greisinger A, Rodriguez-Bigas M, Wolff RA, et al. Feasibility of an expressive-disclosure group intervention for post-treatment colorectal cancer patients: results of the Healthy Expressions study. Cancer. 2011;117:4993–5002. doi:10.1002/cncr.26110. The side effects of colorectal cancer therapy may affect patients' social interaction and have a negative impact on their social support. This study showed that the Healthy Expressions Program, focusing on expressive disclosure, improved psychological function in the post-treatment colorectal cancer patients who reported experiencing distress before treatment.

    Article  PubMed  Google Scholar 

  33. Yang XL, Li HH, Hong MH, Kao HS. The effects of Chinese calligraphy handwriting and relaxation training in Chinese Nasopharyngeal Carcinoma patients: a randomized controlled trial. Int J Nurs Stud. 2010;47:550–9. doi:10.1016/j.ijnurstu.2009.10.014. The study reveals that relaxation relieved insomnia symptoms and improved mood disturbance, while calligraphy elevated level of concentration and improved mood disturbance. Calligraphy is inexpensive and easy to practice, involves an innate art appreciation and cognitive facilitation process, and offers a promising approach to an improved health in cancer patients.

    Article  PubMed  Google Scholar 

  34. Centers for Disease Control and Prevention. United States Cancer Statistics (USCS): 2009 Top Ten Cancers. From http://apps.nccd.cdc.gov/uscs/toptencancers.aspx

  35. Centers for Disease Control and Prevention. United States Cancer Statistics (USCS) cancers ranked by State: 2009 selected cancers ranked by state. From http://apps.nccd.cdc.gov/uscs/cancersrankedbystate.aspx#text

  36. McNair DM, Lorr M, Droppleman LF. EDITS Manual: Profile of Mood States. Educational and Industrial Testing Service: San Diego; 1992.

    Google Scholar 

  37. Akechi T, Okuyama T, Onishi J, Morita T, Furukawa TA. Psychotherapy for depression among incurable cancer patients. Cochrane Database Syst Rev. 2009;4.

  38. Baker F, Denniston M, Zabora J, Polland A, Dudley WN. POMS short form for cancer patients: Psychometric and structural evaluation. Psycho-Oncology. 2002;11:273–81.

    Article  PubMed  Google Scholar 

  39. Chi S, Lin WJ. The preliminary revision of Brief Profile of Mood States (BPOMS)-Chinese Edition. Clin J Ment Health. 2003;17:767–79.

    Google Scholar 

  40. Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC. Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer. 1998;82:1904–908.

    Article  CAS  PubMed  Google Scholar 

  41. Hegel MT, Collins ED, Kearing S, Gillock KL, Moore CP, Ahles TA. Sensitivity and specificity of the Distress Thermometer for depression in newly diagnosed breast cancer patients. Psychooncology. 2008;17:556–60.

    Article  PubMed Central  PubMed  Google Scholar 

  42. National Comprehensive Cancer Network. Distress management practice guidelines. J NCCN. 2003;1:344–74.

    Google Scholar 

  43. Derogatis LR. BSI-18: Brief Symptom Inventory 18: Administration, Scoring, and Procedures Manual. Minneapolis: NCS Pearson Inc.; 2001.

    Google Scholar 

  44. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiat Scand. 1983;67:361–70.

    Article  CAS  PubMed  Google Scholar 

  45. Zigmond AS, Snaith RP, editors. The Hospital Anxiety and Depression Scale with the irritability Depression-Anxiety Scale and the Leads Situational Anxiety Scale Manual. London: GL Assessment Ltd; 1994.

    Google Scholar 

  46. Rodgers J, Martin CR, Morse RC, Kendell K, Verrill M. An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in patients with breast cancer. Health Qual Life Outcome. 2005;3:41. doi:10.1186/1477-7525-3-41.

    Article  Google Scholar 

  47. Biffi R, Orsi F, Pozzi S, Maldifassi A, Radice D, Rotmensz N, et al. No impact of central venous insertion site on oncology patients' quality of life and psychological distress. A randomized three-arm trial. Support Care Cancer. 2011;19:1573–80. doi:10.1007/s00520-010-0984-9.

    Article  PubMed  Google Scholar 

  48. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401. doi:10.1177/014662167700100306.

    Article  Google Scholar 

  49. Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health. 1993;5:179–93.

    Article  CAS  PubMed  Google Scholar 

  50. Grzywacz JG, Hovey JD, Seligman LD, Arcury TA, Quandt SA. Evaluating short-form versions of the CES-D for measuring depressive symptoms among immigrants from Mexico. Hisp J Behav Sci. 2006;28:404–24.

    Article  Google Scholar 

  51. Spielberger CD, Gorsuch RL, Lushene R. Manual for the State– Trait Anxiety Inventory, Paolo Alto, Calif. California: Consulting Psychologists Press; 1970.

    Google Scholar 

  52. Veit CT, Ware JE. The structure of psychological distress and well-being in general population. J Consult Clin Psychol. 1983;51:730–42.

    Article  CAS  PubMed  Google Scholar 

  53. Edwards AG, Hulbert-Williams N, Neal RD. Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev. 2008;3, CD004253. doi:10.1002/14651858.CD004253.pub3.

    PubMed  Google Scholar 

  54. Luckett T, Butow PN, King MT, Oguchi M, Heading G, Hackl NA, et al. A review and recommendations for optimal outcome measure of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Support Care Cancer. 2010;18:1241–62. doi:10.1007/s00520-010-0932-8.

    Article  PubMed  Google Scholar 

  55. Bultz BD, Carlson LE. Emotional distress: the six vital sign in cancer care. J Clin Oncol. 2005;23:6440–1.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Mei-Ling Yeh, Dr. Yu-Chu Chung, Dr. Man-Ying F. Hsu, and Dr. Chin-Che Hsu each declare no potential conflict of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Minte Road, Taipei, Taiwan, Republic of China

    Mei-Ling Yeh

  2. School of Nursing, Yuanpei University, No. 306, Yuanpei Street, Hsinchu, Taiwan, 30015, Republic of China

    Yu-Chu Chung

  3. School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Minte Road, Taipei, Taiwan, Republic of China

    Man-Ying F. Hsu

  4. Department of Dermatology, Kaohsiung Medical College Hospital, 100 Shih Chuan 1st Road, Kaohsiung, Taiwan, 80708, Republic of China

    Chin-Che Hsu

Authors
  1. Mei-Ling Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu-Chu Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Man-Ying F. Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chin-Che Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chin-Che Hsu.

Additional information

This article is part of the Topical Collection on Cancer Pain

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yeh, ML., Chung, YC., Hsu, MY.F. et al. Quantifying Psychological Distress among Cancer Patients in Interventions and Scales: A Systematic Review. Curr Pain Headache Rep 18, 399 (2014). https://doi.org/10.1007/s11916-013-0399-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-013-0399-7

Keywords

Search

Navigation