Self-reported distress and problems after treatment for gynecological cancer - Correlation between a short screening tool and longer measures of anxiety/depression and health-related quality of life

Acta Obstet Gynecol Scand. 2024 Feb;103(2):387-395. doi: 10.1111/aogs.14709. Epub 2023 Nov 22.


Introduction: The National Comprehensive Cancer Network (NCCN) distress thermometer and problem list (DTPL) is a brief self-report screening measure for use in follow-up cancer care. The aims of this study were to explore the correlations between scores on the DTPL and scores on longer measures of anxiety/depression and health-related quality of life among women treated for gynecological cancer, and to define a cutoff score on the DT representing high levels of psychological distress in this patient group.

Material and methods: During outpatient visits, 144 women filled in the DTPL, the Hospital Anxiety and Depression Scale (HADS) and the RAND-36-Item Short Form Health Survey (RAND-36) between October 2019 and March 2020. We assessed the agreement between the DT-scores and the HADS scores, explored variables associated with high levels of distress on the DT, and studied the associations between DTPL-scores and scores of health-related quality of life (HRQoL) from RAND-36.

Results: In receiver operating characteristic curve analysis between the distress score from the DT and a HADS total score ≥15 (defining high levels of anxiety/depression symptoms), the area under the curve was 0.81 (95% CI: 0.74-0.89). Using a cutoff of ≥5 on the DT (scale 0-10), we found a balanced level of sensitivity (81%) and specificity (71%) towards a HADS total score of ≥15. The scores of distress and problems reported on the DTPL correlated significantly with the majority of HRQoL function scales from RAND-36.

Conclusions: The NCCN DTPL can be used as a screening measure for self-reported distress and problems after treatment for gynecological cancer. A score of ≥5 on DT may indicate high level of anxiety/depression as measured by HADS. The tool may help identify patients in need of referral to supportive care and rehabilitation facilities.

Keywords: distress thermometer aftercare; gynecological neoplasms; health-related quality of life; psychological distress; psychometrics.

MeSH terms

  • Anxiety / diagnosis
  • Anxiety / psychology
  • Depression* / diagnosis
  • Depression* / psychology
  • Early Detection of Cancer
  • Female
  • Humans
  • Mass Screening
  • Neoplasms* / psychology
  • Psychometrics
  • Quality of Life / psychology
  • Self Report
  • Stress, Psychological / diagnosis
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires