Validation of the Distress Thermometer: A single item screen to detect clinically significant psychological distress in ambulatory oncology patients.

6024 Background: Psychosocial distress in ambulatory oncology patients (AOP) is common, and deleterious to treatment decisions, symptoms, adherence and outcomes, but easily treated. Recent NCCN guidelines recommend all AOP be screened at initial patient visit (IPV) and "appropriate intervals" to determine level, nature and cause of distress and to inform intervention. The brevity of the Memorial Sloan-Kettering Distress Thermometer (DT), a one item self-report measure, warrants the NCCN's endorsement, however, operating characteristics of the DT, and the companion Problem List (PL) are not well established. METHODS All AOP presenting to clinic over 36 weeks for IPV (n = 1272; 15-97 YO, mean = 54.7; 31% male) completed NCCN recommended DT and PL, well-validated Hospital Anxiety and Depression Scale (HADS), and health history. Receiver operating characteristics (ROC) analysis established sensitivity and specificity of DT to detect caseness and optimal cutoffs for use as distress screen in AOP. RESULTS DT is significantly correlated (p = 0.00) with HADS total (HADS-T, r = 0.70), Anxiety (HADS-A, r = 0.68) and Depression (HADS-D, r = 0.54) scales. Area under ROC Curve is greater for HADS-T (87.6%) and HADS-A (84.9%) than HADS-D (80.2%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for recommended cutoff s (>4 and >5) of DT are in table below. CONCLUSIONS DT better predicts caseness for global distress (GD) and anxiety (ANX), than depression (DEP), which is less prevalent but no less important in AOP (DEP = 14.3%; ANX = 36.1%; GD = 23.3%). As sensitivity to detect GD, ANX and DEP is adequate at both cutoffs, but proportion of patients identified as cases differs significantly (>4 = 40%; >5 = 27%), optimal cutoff point of DT for routine screening may be based on available resources to evaluate identified cases. [Figure: see text] No significant financial relationships to disclose.