Some level of distress is experienced by nearly every patient having to deal with a wide variety of stressors at different stages of disease and treatment;[1,2] however, only a small percentage of those in distress receive appropriate help. Standards of care have been developed for the management of psychosocial distress.
The National Comprehensive Cancer Network (NCCN)  has the broad goal of establishing standards of care so that all patients experiencing psychosocial distress will be accurately and routinely identified, recognized, and treated. These guidelines include recommendations for the following:
- Initial evaluation.
Also included are referral and treatment guidelines for each participating profession:
The times most likely to require screening include the following periods during the illness when distress is most likely to occur:
- Shortly after diagnosis.
- At start of treatment (surgery, radiation, and chemotherapy).
- At conclusion of a long course of treatment.
- Periodically during posttreatment and remission.
- At time of recurrence.
- With transition to palliative care.
Because there continues to be a stigma attached to terms such as psychological,psychiatric, or even emotional, the term distress was chosen by NCCN to represent an accurate yet less stigmatizing concept. Distress has been defined as "an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. It extends along a continuum, from common normal feelings of vulnerability, sadness, and fears, to problems that are disabling, such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis." (Refer to the Overview section of this summary for more information.)
The psychometric properties of the NCCN rapid-screening measure (a 0-10 visual analogue scale, in the form of a thermometer labeled with "No Distress" at 0, "Moderate Distress" at the midpoint, and "Extreme Distress" at 10) have been investigated. The measure was found to have reasonable convergent and divergent validity when compared to two more well-established, multidimensional symptom inventories. This very brief rapid-screening procedure was found to have a moderate ability to accurately detect distress as defined by scores indicative of "caseness" on the two-symptom inventories. When specific cutoff scores were tested to maximize sensitivity and specificity, no single cutoff that maximized accuracy of classification was discovered. Thus, it was recommended that varying cutoff scores result in different referral recommendations, such that low scores result in no referral, moderate scores result in an optional referral, and high scores strongly recommend further interventions.
The accuracy of these ultrashort screening methods (containing fewer than five items and taking less than 2 minutes to complete) has been investigated.[4,5] A review of 38 studies testing the accuracy of these methods for identifying depression, anxiety, and distress found that the ultrashort methods achieve modest overall accuracy. These screening methods were best at ruling out anxiety, depression, or distress and performed poorly at accurately ruling in anxiety, depression, or distress, thereby resulting in a high number of false positives. Thus, it is recommended that when an ultrashort screening method is used, a more complete psychosocial assessment interview should follow the initial screening.