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NCCN Guidelines for Patients



Distress, Version 1.2017


What is distress?

Causes and risks



Guide 2. Risk factors for higher distress

You are more likely to be distressed if you:

• Have uncontrolled symptoms

• Have spiritual or religious concerns

• Have a severe illness other than cancer

• Have family conflicts

• Have cognitive impairment

• Have a lack of social support

• Have limited access to health care

• Live alone

• Are younger in age

• Have young children

• Are a woman

• Have been physically or sexually abused

• Have barriers to communicating

• Have had a substance use disorder (ie, alcohol,


• Have money problems

• Have had a mental disorder (eg, anxiety,


Guide 3. Vulnerable periods for distress

You are more likely to become distressed if you:

• Learn a symptom needs more testing

• Were just admitted to or discharged from the hospital

• Are being assessed for cancer

• Recently finished treatment

• Just learned the diagnosis

• Are in follow-up care

• Are undergoing genetic testing

• Learn treatment didn’t work

• Are waiting for treatment

• Learn the cancer has returned or progressed

• Are starting another type of treatment

• Have advanced cancer

• Have a major treatment-related complication

• Are near to the end of life