The Distress Thermometer for screening for severe fatigue in newly diagnosed breast and colorectal cancer patients

Psychooncology. 2017 May;26(5):693-697. doi: 10.1002/pon.4208. Epub 2016 Jul 28.


Objective: Internationally, the Distress Thermometer and associated Problem List are increasingly used in oncology as screening tools for psychological distress. Cancer-related fatigue is common but often overlooked in clinical practice. We examined if severe fatigue in cancer patients can be identified with the fatigue item of the Problem List.

Methods: Newly diagnosed breast (N = 334) and colorectal (N = 179) cancer patients were screened for severe fatigue, which was defined as having a positive score on the fatigue item of the Problem List. The Fatigue Severity subscale of the Checklist Individual Strength was used as gold standard measure for severe fatigue.

Results: In total, 78% of breast cancer patients and 81% of colorectal cancer patients were correctly identified with the fatigue item. The sensitivity was 89% in breast cancer patients and 91% in colorectal cancer patients. The specificity was 75% in breast cancer patients and 77% in colorectal cancer patients. The positive predictive value was 53% in breast cancer patients and 64% in colorectal cancer patients, whereas the negative predictive value was 95% in both tumor types.

Conclusions: The fatigue item of the Problem List performs satisfactorily as a quick screening tool for severe fatigue. However, a positive screen should be followed up with a more thorough assessment of fatigue, ie, a questionnaire with a validated cutoff point. Given time pressure of clinicians, this already implemented and brief screening tool may prevent severe fatigue from going undetected in clinical practice.

Keywords: Distress Thermometer; cancer; fatigue; oncology; psychometric properties; screening.

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Aged
  • Breast Neoplasms / psychology*
  • Checklist
  • Colorectal Neoplasms / psychology*
  • Fatigue / diagnosis*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Stress, Psychological / diagnosis
  • Surveys and Questionnaires