Background: The Distress Thermometer (
DT) is a screening tool recommended to quickly identify cancer patients with distress. Our study aimed to examine the sensitivity and specificity of the
DT in detecting psychological distress in long-term Chinese nasopharyngeal cancer (
NPC) survivors.
Methods: Data for the 442 participating
NPC survivors were collected through a self-administered questionnaire based on the
DT and the Hospital Anxiety and Depression Scale (
HADS). The
HADS was used to define cases of psychological distress. Positive and negative groups were defined based on 4
HADS criteria (Anxiety, Depression, Anxiety or Depression, and overall score). Receiver operating characteristic (
ROC) curves were used to examine the ability of all possible cut-off values of the
DT to detect positive and negative cases. For each
ROC curve, the area under the curve (
AUC) was used as an indicator of the overall accuracy of the
DT to identify positive cases of distress.
Results: The positive
AUC values [with 95% confidence intervals (
CI)] for the 4
HADS criteria were 0.715 (95%
CI: 0.667 to 0.764), 0.714 (95%
CI: 0.661 to 0.768), 0.724 (95%
CI: 0.677 to 0.771), and 0.724 (95%
CI: 0.664 to 0.775) respectively. At a cut-off score of 4, the sensitivity of the
DT to the four
HADS criteria was, respectively, 0.366 (95%
CI: 0.296 to 0.436), 0.448 (95%
CI: 0.364 to 0.532), 0.362 (95%
CI: 0.299 to 0.425), and 0.421 (95%
CI: 0.339 to 0.502), and the specificity of the
DT to the 4
HADS criteria was, respectively, 0.860 (95%
CI: 0.818 to 0.902), 0.860 (95%
CI: 0.821 to 0.899), 0.854 (95%
CI: 0.814 to 0.894), and 0.854 (95%
CI: 0.814 to 0.894). At a cut-off score of 5, the corresponding sensitivities were lower than those at the cut-off score of 4. All potential cut-off scores showed poor sensitivity (<0.90).
Conclusions: The
ROC analysis showed poor discrimination. No potential
DT cut-off score had an acceptable sensitivity. The
DT showed poor sensitivity in
NPC survivors. Thus, the
DT might not be a valid scale for psychological distress screening in long-term Chinese
NPC survivors.
Full article