SCREENING FOR DISTRESS IN BREAST CANCER PATIENTS IN ALBANIA WITH A CANCER SPECIFIC QUESTIONNAIRE
Abstract
Objective: Based on evidence that psychologic distress often goes unrecognized although it is common among cancer patients, clinical practice guidelines recommend routine screening for distress. To date, however, only a minority of cancer centers worldwide have implemented emotional distress screening of patients with standardized tools. The aim of this study is to examine the validation and reliability of the distress thermometer (DT) recommended by National Comprehensive Cancer Network (NCCN) in Albanian cancer patients in order to identify patients who may need further psychosocial care and to analyze whether distress may affect in any way the outcomes of cancer treatment.
Materials and Methods: 289 breast cancer patients were recruited. All patients completed National Comprehensive Cancer Network Distress Thermometer (DT) and Emotional Symptoms. The analyzed variables were age, type of surgery, DT scale, emotional symptoms, psychiatric diagnosis and follow-up by checking patients` medical records. To analyze the data, descriptive statistics, Chi-square test and ROC analysis using SPSS were used.
Results: The mean age was 54 years. All patients recruited were stage I (41.9%) and stage II (49.1%) breast cancer. They all underwent breast surgery. The emotional distress distribution based on the Distress Thermometer shows that 139 patients (48.1%) had a low rate of emotional distress (score ≤4) and 150 patients (51.9%) had a high rate of emotional distress (score >4), with a mean score of 4.64. A cutoff of 5 maximized sensitivity and specificity, which were 0.759 and 0.285 respectively assessed with ROC curve. A statistically significant correlation has been found between high scores in DT and not regular follow-ups of patients after the end of treatment, p<0.01. Patients who scored ≥5 in the DT were more likely to not keep up with regular followups.
Conclusions: Implementation of a reliable screening distress for breast cancer patients in Albania is highly recommended since it may positively affect the quality of life of cancer patients and cancer prognosis itself.
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