Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Neue diagnostische Verfahren/New Diagnostic Procedures

Die deutsche Version des NCCN Distress-Thermometers

Empirische Prüfung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten

Published Online:October 03, 2006https://doi.org/10.1024/1661-4747.54.3.213

Abstract

Zusammenfassung: Das NCCN Distress-Thermometer ist ein vom National Comprehensive Cancer Network (NCCN) entwickeltes Screeninginstrument zur Erfassung psychosozialer Belastungen bei onkologischen Patienten. Es besteht aus einer Skala von 0 bis 10 und einer Problemliste als Überweisungsschema zu entsprechenden professionellen Diensten. International wird ein Cut-off-Wert von 5 als Signal empfohlen, dass ein Patient auffällig belastet ist und Unterstützung benötigt. Die deutsche Adaptation erfolgte an einer Stichprobe von n = 475 Krebspatienten in der onkologischen Rehabilitation. Zur Validierung wurde die Hospital Anxiety and Depression Scale (HADS-D) und die Kurzform des Fragebogens zur Progredienzangst (PA-F 12) eingesetzt. Die Diskriminationsfähigkeit des Distress-Thermometers ist besonders zur Identifikation einer hohen Belastung (HADS Cut-off > 11) mit AUC-Werten von 0.71 bis 0.76 gut. Bei einem Cut-off-Wert von 5 im Distress-Thermometer zeigen sich bei moderater Belastung in den Merkmalen Angst und/oder Depressivität (HADS Cut-off > 8) eine Sensitivität bis 84 % und eine deutlich niedrigere Spezifität von bis zu 47 %. Bei einem HADS Cut-off > 11 und einem Cut-off-Wert von 5 im Distress-Thermometer liegen die Sensitivitätswerte bei bis zu 97 % und die Spezifitätswerte bei 41 %. Die Spezifität des Instruments ist in der deutschen Stichprobe niedriger als die in internationalen Studien gefundenen Werte, die Sensitivität ist entsprechend höher. Das NCCN Distress-Thermometer stellt aufgrund seiner hohen Akzeptanz, seiner Kürze und guten Praktikabilität im klinischen Alltag ein Screeninginstrument dar, das für den weiteren Einsatz in der onkologischen Versorgung empfohlen werden kann.


The German Version of the NCCN Distress Thermometer: Validation of a Screening Instrument for Assessment of Psychosocial Distress in Cancer Patients

Abstract: The NCCN Distress-Thermometer is a brief screening tool for cancer patients to assess distress. It has been developed by the National Comprehensive Cancer Network (NCCN) in the US. It consists of a scale from 0-10 and a problem list which provides information to which health care professionals a patient should be referred. A score of 5 is internationally recommended as an indicator that a patient is distressed and needs support. For the German adaptation, a sample of n = 475 cancer patients was assessed during oncological rehabilitation. To validate the screening tool, we used the Hospital Anxiety and Depression Scale (HADS-D) and the brief version of the Fear of Progression Questionnaire (PA-F 12). The discriminating power of the Distress-Thermometer was particularly good when screening for higher levels of anxiety or/and depression (HADS Cut-off > 11): AUC from 0.71 to 0.76. For a score of 5 in the Distress-Thermometer, we found a sensitivity up to 84 % and a lower specifity up to 47 % when screening for moderate levels of anxiety or/and depression (HADS Cut-off > 8). Screening for a higher level of distress (HADS Cut-off > 11), we found a sensitivity up to 97 % and a specifity up to 41 % when using a score of 5 in the Distress-Thermometer. The specifity of the instrument is lower as the values for specifity found in international studies, but the sensitivity is little higher in the German sample. Due to its high acceptance, its brevity and practice orientation, the NCCN Distress-Thermometer can be recommended as a screening tool to assess psychosocial distress in cancer patients.

References

  • Akizuki, N. , Akechi, T. , Nakanishi, T. , Yoshikawa, E. , Okamura, M. , Nakano, T. , Murakami, Y. , Uchitomi, Y. (2003). Development of a brief screening interview for adjustment disorders and major depression in patients with cancer. Cancer , 97 , 2605– 2613 First citation in articleCrossref, Google Scholar

  • Akizuki, N. , Yamawaki, S. , Akechi, T. , Nakano, T. , Uchitomi, Y. (2005). Development of an Impact Thermometer for use in combination with the Distress Thermometer as a brief screening tool for adjustment disorders and/or major depression in cancer patients. Journal of Pain and Symptom Management , 29 , 91– 99 First citation in articleCrossref, Google Scholar

  • Colleoni, M. , Mandala, M. , Peruzzotti, G. , Robertson, C. , Bredart, A. , Goldhirsch, A. (2000). Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet , 356 , 1326– 1327 First citation in articleCrossref, Google Scholar

  • Dankert, A. , Duran, G. , Engst-Hastreiter, U. , Keller, M. , Waadt, S. , Henrich, G. , Herschbach, P. (2003). Fear of progression in patients with cancer, diabetes mellitus and chronic arthritis. Die Rehabilitation , 42 , 155– 163 First citation in articleCrossref, Google Scholar

  • Eakin, E.G. , Strycker, L.A. (2001). Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer: Patient and provider perspectives. Psycho-Oncology , 10 , 103– 113 First citation in articleCrossref, Google Scholar

  • Faller, H. , Bulzebruck, H. , Drings, P. , Lang, H. (1999). Coping, distress, and survival among patients with lung cancer. Archives of General Psychiatry , 56 , 756– 762 First citation in articleCrossref, Google Scholar

  • Fawzy, F.I. , Fawzy, N.W. , Arndt, L.A. , Pasnau, R.O. (1995). Critical review of psychosocial interventions in cancer care. Archives of General Psychiatry , 52 , 100– 113 First citation in articleCrossref, Google Scholar

  • Fawzy, F.I. , Fawzy, N.W. , Hyun, C.S. , Elashoff, R. , Guthrie, D. , Fahey, J.L. , Morton, D.L. (1993). Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Archives of General Psychiatry , 50 , 681– 689 First citation in articleCrossref, Google Scholar

  • Gil, F. , Grassi, L. , Travado, L. , Tomamichel, M. , Gonzalez, J.R. Southern European Psycho-Oncology Study Group (2005). Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients. Supportive Care in Cancer , 13 , 600– 606 First citation in articleCrossref, Google Scholar

  • Hermann, C. , Buss, U. , Snaith, R.P. (1995). HADS-D: Hospital Anxiety and Depression Scale - Deutsche Version. Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin . Bern: Huber First citation in articleGoogle Scholar

  • Hewitt, M. , Herdman, R. , Holland, J.C. Eds. (2004). Meeting psychosocial needs of women with breast cancer. Institute of Medicine and National Research Council of the National Academies . Washington, DC: The National Academies Press First citation in articleGoogle Scholar

  • Hoffman, B.M. , Zevon, M.A. , D'Arrigo, M.C. , Cecchini, T.B. (2004). Screening for distress in cancer patients: The NCCN rapid-screening measure. Psycho-Oncology , 13 , 792– 799 First citation in articleCrossref, Google Scholar

  • Holland, J.C. Ed. (1998). Psycho-oncology . New York: Oxford University Press First citation in articleGoogle Scholar

  • Holland, J.C. (1999). NCCN practice guidelines for the management of psychosocial distress. Oncology , 13 , 113– 147 First citation in articleGoogle Scholar

  • Holland, J.C. (2000). An algorithm for rapid assessment and referral of distressed patients. In M.C. Perry (Ed.), American Society of Clinical Oncology educational book (pp. 129-138). Alexandria, VA: American Society of Clinical Oncology First citation in articleGoogle Scholar

  • Holland, J.C. (2002). History of Psycho-Oncology: Overcoming attitudinal and conceptual barriers. Psychosomatic Medicine , 64 , 206– 221 First citation in articleCrossref, Google Scholar

  • Jacobsen, P.B. , Donovan, K.A. , Trask, P.C. , Fleishman, S.B. , Zabora, J. , Baker, F. , Holland, J.C. (2005). Screening for psychologic distress in ambulatory cancer patients. Cancer , 103 , 1494– 1502 First citation in articleCrossref, Google Scholar

  • Lübbert, K. , Dahme, B. , Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review. Psycho-Oncology , 10 , 490– 502 First citation in articleCrossref, Google Scholar

  • McCormick, T.R. , Conley, B.J. (1995). Patients' perspectives on dying and on the care of dying patients. The Western Journal of Medicine , 163 , 236– 243 First citation in articleGoogle Scholar

  • Mehnert, A. , Koch, U. (2005). Psychosocial care of cancer patients - International differences in definition, healthcare structures, and therapeutic approaches. Supportive Care in Cancer , 13 , 579– 588 First citation in articleCrossref, Google Scholar

  • Meyer, T.J. , Mark, M.M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology , 14 , 101– 108 First citation in articleCrossref, Google Scholar

  • National Comprehensive Cancer Network (NCCN) (2003). Distress management clinical practice guidelines. Journal of the National Comprehensive Cancer Network , 1 , 344– 374 First citation in articleGoogle Scholar

  • National Comprehensive Cancer Network (NCCN) (2004). The Nationale Comprehensive Cancer Network and the American Cancer Society. Distress treatment guidelines for patients . www.nccn.org First citation in articleGoogle Scholar

  • Newell, S.A. , Sanson-Fisher, R.W. , Savolainen, N.J. (2002). Systematic review of psychological therapies for cancer patients: Overview and recommendations for future research. Journal of the National Cancer Institute , 94 , 558– 584 First citation in articleCrossref, Google Scholar

  • Parker, P.A. , Baile, W.F. , de Moor, C. , Cohen, L. (2003). Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psycho-Oncology , 12 , 183– 193 First citation in articleCrossref, Google Scholar

  • Ransom, S. , Jacobsen, P.B. , Booth-Jones, M. (2005). Validation of the Distress Thermometer with bone marrow transplant patients. Psycho-Oncology , 10.1002/pon.993 (DOI) First citation in articleGoogle Scholar

  • Rehse, B. , Pukrop, R. (2003). Effects of psychosocial interventions on quality of life in adult cancer patients: Meta analysis of 37 published controlled outcome studies. Patient Education and Counseling , 50 , 179– 186 First citation in articleCrossref, Google Scholar

  • Roth, A.J. , Kornblith, A.B. , Batel-Copel, L. , Peabody, E. , Scher, H.I. , Holland, J.C. (1998). Rapid screening for psychologic distress in men with prostate carcinoma: A pilot study. Cancer , 82 , 1904– 1908 First citation in articleCrossref, Google Scholar

  • Roth, A.J. , Rosenfeld, B. , Kornblith, A.B. , Gibson, C. , Scher, H.I. , Curley-Smart, T. , Holland, J.C. , Breitbart, W. (2003). The memorial anxiety scale for prostate cancer: Validation of a new scale to measure anxiety in men with with prostate cancer. Cancer , 97 , 2910– 2918 First citation in articleCrossref, Google Scholar

  • Trask, P.C. , Paterson, A. , Riba, M. , Brines, B. , Griffith, K. , Parker, P. , Weick, J. , Steele, P. , Kyro, K. , Ferrara, J. (2002). Assessment of psychological distress in prospective bone marrow transplant patients. Bone Marrow Transplantation , 29 , 917– 925 First citation in articleCrossref, Google Scholar

  • Trijsburg, R.W. , van Knippenberg, F.C.E. , Rijpma, S.E. (1992). Effects of psychological treatment on cancer patients: A critical review. Psychosomatic Medicine , 54 , 489– 517 First citation in articleCrossref, Google Scholar

  • van't-Spijker, A. , Trijsburg, R.W. , Duivenvoorden, H.J. (1997). Psychological sequelae of cancer diagnosis: A meta-analytical review of 58 studies after 1980. Psychosomatic Medicine , 59 , 280– 293 First citation in articleCrossref, Google Scholar

  • Watson, M. , Haviland, J.S. , Greer, S. , Davidson, J. , Bliss, J.M. (1999). Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet , 354 , 1331– 1336 First citation in articleCrossref, Google Scholar

  • Weis, J. , Koch, U. , Matthey, K. , Wilhelm, P. (1998). Ist-Analyse der psychosozialen Versorgung von Krebspatienten im Akut- und Rehabilitationsbereich. In U. Koch & J. Weis (Hrsg.), Krankheitsbewältigung bei Krebs und Möglichkeiten der Unterstützung (S. 331-341). Stuttgart: Schattauer First citation in articleGoogle Scholar

  • Zigmond, A.S. , Snaith, R.P. (1983). The Hospital and Depression Scale. Acta Psychiatrica Scandinavica , 67 , 361– 370 First citation in articleCrossref, Google Scholar