Distress among cancer patients: some considerations in identification and treatment

Abstract

This article discusses the merits of screening for distress in the context of a chronic illness, such as cancer, with a particular focus on resource-constrained health care systems such as those in low-and-middle income countries. Despite calls for distress to be considered a vital sign, like pain it is not objectively verifiable as it relies solely on the person’s subjective appraisal. Accordingly, the Distress Thermometer has limited validity considering its concordance with the Hospital Anxiety and Depression Scale, which itself has limitations in terms of its psychometric properties. Indeed, an elevated score on a self-report measure does not indicate caseness for a mental health condition. Distress is often self-limiting and transient, whereas common mental disorders require evidence-informed treatment. In the context of scarce resources as is the case in low-and-middle income countries, efforts should instead be directed at identifying common mental disorders among persons living with cancer and others who have serious health threats. Such an approach will increase the likelihood of resources being directed at those who are most likely to benefit from psychological interventions. Where persons living with cancer indicate the need for psychosocial services, ways to manage distress include problem-solving therapy, motivational interviewing, and mindfulness-based stress reduction.