In regard to predictors of posttreatment distress, a longitudinal, observational study of 151 women with early-stage breast cancer found that physical symptoms and side effects experienced during treatment were predictive of posttreatment cancer-related distress, amounting to 6% of the total 24% of variance accounted for. In addition, demographic variables associated with this posttreatment cancer-related distress included younger age, nonwhite racial status, and less formal education. Clinical variables associated with distress included having a mastectomy rather than lumpectomy, receiving hormonal treatment, and the presence of a diagnosable mental disorder at the time of recruitment into the study.
Screening and assessment have been viewed as two distinct processes.[14,15] Screening is a rapid method of identifying patients with psychosocial distress, typically done by using brief self-report questionnaires administered by non-mental-health professionals with the goal of determining who needs referral for more extensive assessment. The psychosocial assessment of the cancer patient is a more in-depth clinical interview focused on factors relevant to coping and adaptation. Mental health professionals do the assessment interview with the goal of determining how well a patient is adjusting.
Various comprehensive cancer centers have developed models for screening for psychosocial distress. Although there are notable differences, most models involve the following sequential steps:
- Screening administration.
- Scoring and evaluation.
Most screening for psychosocial distress is focused on the individual patient; however, some family-focused screening procedures are being developed.
Administration of a screening instrument involves a brief 5- to 10-minute process in which each patient answers a series of simple, straightforward questions about distress, either orally or via a self-report questionnaire or computer. Answers are scored and evaluated on the basis of previously determined criteria. If scores are above the defined criteria, then a formal referral to the appropriate discipline (social work, psychology, psychiatry, palliative care, pastoral care) is made. Distress management then begins with a more comprehensive face-to-face psychosocial assessment interview  by a qualified health care professional (e.g., social worker, psychologist, psychiatrist, palliative care specialist, pastoral counselor).
Few empirical studies have evaluated the impact of structured screening programs. In two randomized, longitudinal, intervention studies, no significant differences in quality of life were found.[18,19] In one of these studies, however, a subgroup of moderately to severely depressed patients showed a significant reduction in depression following the intervention. Thus, further empirical evaluation of the effectiveness of screening programs is needed. The following examples will help to illustrate the process.
Model screening programs
Memorial Sloan-Kettering Cancer Center has experimented with a distress thermometer modeled after those used to measure pain. The descriptive anchor points on the thermometer include the following:
- "No distress" at a rating of 0.
- "Moderate distress" at a rating of 5.
- "Extreme distress" at a rating of 10.