NCCN Guidelines for Patients
Distress, Version 1.2017
Causes and risks
There isn’t one cause of distress. What causes
distress for one person with cancer may not be the
same for another person. For example, people who
are distressed may feel overwhelmed. Some have
many side effects from treatment. Others struggle
with worries or have money problems. Even if you
have been wise with your money, the costs related to
cancer can add up.
Anyone can become distressed but research has
found that some people are more likely than others.
The risk factors for higher levels of distress are listed
. A risk factor is anything that increases
the chance of an event. There is a wide range of risk
factors for distress.
You may have health-related risk factors. Some
people have symptoms from the cancer, from the
cancer treatment, or both. If your symptoms are
severe or long lasting, your chance of becoming
distressed is increased. Having another severe
illness, cognitive impairment, or limited access to
health care can also lead to distress.
You may have personal risk factors. Such factors
include being young, being a woman, and having
problems with communication. It may be a shock
to learn that you have cancer. Likewise, it may be
too much to deal with cancer and your everyday
duties. Your chance for becoming distressed is also
increased if you don’t know the words your treatment
team uses or you don’t have access to information.
Money may get even tighter. You may have less
money due to travel costs, insurance co-payments,
and missing work. With less money, your chance of
becoming distressed is increased.
Spiritual and social factors can contribute to distress.
You may have long-standing or new spiritual or
religious concerns in the context of having cancer.
Family conflicts, a lack of family support, and living
alone may increase the burden of having cancer
and lead to distress. Having young children is an
important responsibility. Raising children and dealing
with cancer at the same time can be very hard to do.
Higher levels of distress are linked to sexual and
physical abuse, substance use disorders (ie, alcohol,
drugs), and other mental disorders. If you have been
abused, you are more likely to become distressed at
some point during your cancer care. If you have had
a mental or substance use disorder, your chance of
being distressed is higher than someone who has
Distress can occur at any point in time during your
cancer journey. However, there are times when being
distressed is more likely. Read
for a list of
times of when you are more likely to be distressed.
Distress may result from learning you have cancer. It
may also occur beforehand when being assessed for
cancer. Transitions in care can also lead to distress.
Examples of a transition include being discharged
from the hospital or finishing all treatment. It can be a
big change when shifting from frequent doctor visits
during active treatment to less frequent visits during
follow-up care. Another common time point for being
distressed is learning that your health has worsened.
Ideally, you would be screened for distress at every
health care visit. However, it is very important that
you be assessed for distress at the time points listed
in Guide 3. Screening tools for distress are described
in Part 2 along with some of the benefits of distress
What is distress?
Causes and risks