NCCN Guidelines for Patients
Distress, Version 1.2017
How distressed are you?
Assessing distress is a key part of cancer
care. Part 2 is a review of the screening
process for distress. Screening tools are
described and the benefits of screening
are explained. You can also learn who can
help you with reducing distress.
A screening tool is a short assessment for a
condition. For distress, screening tools prompt you
to respond to one or more verbal statements or
questions. Distress screening tools have been tested
in research studies. They have been found to work
well for detecting who is distressed and pinpointing
people’s psychosocial needs.
There is more than one screening tool for distress.
Screening tools are often paper-based surveys.
However, hand-held devices, interactive voice
responses, and internet-based programs have also
been used. The screening tools created by NCCN
experts in distress are described next.
The Distress Thermometer and Problem List
The Distress Thermometer is a well-known screening
tool among cancer care providers. It has been shown
in many studies to work well. It measures distress on
a 0 to 10 scale.See page 16.
To report your distress,
circle the number that matches your level of distress
in the past week.
The Problem List is completed along with the
Distress Thermometer. It will help your cancer care
team learn what is causing your distress. In turn,
your team can ask better follow-up questions and
refer you to the right help if needed.
You may receive a screening tool for distress at your
next doctor’s visit. You may complete the screen
while in the waiting room. If you are not screened for
distress, share this book and your scores with your
cancer care team.
Your cancer care team will discuss your scores
with you. Some types of distress may be managed
by your cancer care team. Other types may be
better addressed by people with a different set of
knowledge and skills. The experts in distress are
described later in this chapter.
Distress screening is usually a quick process. If
paired with getting help as needed, it can yield major
benefits. Some of the benefits of distress screening
are listed next.
Detects who is distressed
. Without standard
screening, less than half of distressed people are
identified and get the help they need. Often, doctors
don’t ask and patients don’t tell their doctors about
their distress. Screening tools empower doctors to
inquire about distress and empower patients to share
how they are feeling. Read Part 4 to learn about
distress screening becoming a standard of care for
people with cancer.
. You may receive an in-depth
assessment depending on what is bothering you. An
example is memory testing if you say your memory
is a big problem. Another example is a clinical
assessment for high distress about sexual problems
or pain. A clinical assessment may consist of one or
more of the following: an interview, survey, or health
Better distress management
. Early distress
screening leads to timely management of distress.
A study of routine screening showed that distressed
people referred to help as needed were less