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Journal of the National Cancer Institute Advance Access originally published online on October 13, 2009
JNCI Journal of the National Cancer Institute 2009 101(21):1464-1488; doi:10.1093/jnci/djp336
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© The Author 2009. Published by Oxford University Press.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

REVIEW

Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments

Andrea Vodermaier, Wolfgang Linden, Christopher Siu

Affiliations of authors: Department of Psychology, University of British Columbia, Vancouver, BC, Canada (AV, WL, CS); Department of Obstetrics and Gynaecology, Grosshadern, University of Munich, Germany (AV); BC Cancer Agency, Vancouver, BC, Canada (WL)

Correspondence to: Andrea Vodermaier, PhD, Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4 (e-mail: avoderma{at}psych.ubc.ca).

Screening for emotional distress is becoming increasingly common in cancer care. This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress, with the goal of encouraging screening programs to use standardized tools that have strong psychometrics. Systematic searches of MEDLINE and PsycINFO databases for English-language studies in cancer patients were performed using a uniform set of key words (eg, depression, anxiety, screening, validation, and scale), and the retrieved studies were independently evaluated by two reviewers. Evaluation criteria included the number of validation studies, the number of participants, generalizability, reliability, the quality of the criterion measure, sensitivity, and specificity. The literature search yielded 106 validation studies that described a total of 33 screening measures. Many generic and cancer-specific scales satisfied a fairly high threshold of quality in terms of their psychometric properties and generalizability. Among the ultrashort measures (ie, those containing one to four items), the Combined Depression Questions performed best in patients receiving palliative care. Among the short measures (ie, those containing five to 20 items), the Center for Epidemiologic Studies–Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties. Among the long measures (ie, those containing 21–50 items), the Beck Depression Inventory and the General Health Questionaire–28 met all evaluation criteria. The PsychoSocial Screen for Cancer, the Questionnaire on Stress in Cancer Patients–Revised, and the Rotterdam Symptom Checklist are long measures that can also be recommended for routine screening. In addition, other measures may be considered for specific indications or disease types. Some measures, particularly newly developed cancer-specific scales, require further validation against structured clinical interviews (the criterion standard for validation measures) before they can be recommended.

Manuscript received October 16, 2009; revised July 28, 2009; accepted August 26, 2009.


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J Natl Cancer Inst 2009 101: 1435. [Extract] [Full Text] [PDF]





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