T276 - -A Large Scale Validation of the Emotion Thermometers as
  T276 A Large Scale Validation of the Emotion Thermometer...
Audit / Research Protocol

   Phase I – DT across LNR network (incl training)


   Phase II – Enhancements to DT


   Phas...
Phase I
Qualitative Limitations of DT
DT not always interpreted by patients

Distress not always understood by patients

There is ...
Quantitative Limitations of DT
Of 401 chemotherapy attendees

  59% have an emotional complication (3v4)

  37% (62% of 59...
Phase II
ET - Table of Cut-Points
              Distress     Anxiety     Depression   Anger        Help
              Thermomete   ...
1.00


0.90


0.80
                                                               Ten
0.70                                ...
DepT
 DT
                                                               23%
37%
                        4%                ...
Phase II
Top 10 patient concerns
         1 Anxiety             312

         2 Family concerns     157

         3 Independence/Ro...
Concerns linked with distress

     t = 7.705129   P < 0.0001   Anxiety

     t = 4.859186   P < 0.0001   depression/hopel...
Validity of the ET
Vs            DT    DepT
HADS-A




AUC:
DT=0.82
DepT=0.84
AnxT=0.87    AnxT   AngT
AngT=0.685
Graphical – Screening principles

 #
 of                            Cut-Off
 Individuals
                               Lo...
Validity Against HADS-T (distress)
We analysed data collected from Leicester Cancer Centre
 from 2007-2009

The researcher...
HADS-T
In the parent sample of 660:

           SE    SP            AUC     CUT
DT –    71.9%    78.4%         0.814   cut...
HADS-T
In the parent sample of 660:

           SE    SP            AUC     CUT
DT –    71.9%    78.4%         0.814   cut...
Against MDD

The researcher applied criteria for MDD. We collated full data on
  660 patient assessments

MDD was defined ...
Validity vs MDD - Results


          SENSITIVITY       SPECIFICITY   AUC

DT –      82.4%             68.6%         0.811
Validity vs MDD - Results


          SENSITIVITY       SPECIFICITY   AUC

DT –      82.4%             68.6%         0.811...
Whole Sample vs MDD

100.00%

                                            Sensitivity
 90.00%
                            ...
Validity vs MDD – 15% minorities

                  SENSITIVITY   SPECIFICITY   AUC

DT BSA        -   100%          56.9%...
BSA vs MDD

100%

                                         Sensitivity
90%
                                         Specif...
Summary
Against Distress

     All thermometers were “good” but DepT was best

Against Depression (all)

     DepT > DT we...
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IPOS10 T276 - Large Scale Validation of the Emotion Thermometers as a Screening Tool for Major Depression in an Ethnically Diverse Cancer Popn

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IPOS10 T276 - Large Scale Validation of the Emotion Thermometers as a Screening Tool for Major Depression in an Ethnically Diverse Cancer Popn

  1. 1. T276 - -A Large Scale Validation of the Emotion Thermometers as T276 A Large Scale Validation of the Emotion Thermometers as aaScreening Tool for MDD & Distress in an Ethnically Diverse Screening Tool for MDD & Distress in an Ethnically Diverse Cancer Population Cancer Population Alex Mitchell www.psycho-oncology.info Paul Symonds Lorraine Grainger Elena Baker-Glenn Department of Cancer & Molecular Medicine, Leicester Royal Infirmary IPOS 2010
  2. 2. Audit / Research Protocol Phase I – DT across LNR network (incl training) Phase II – Enhancements to DT Phase III - Screening plus Intervention
  3. 3. Phase I
  4. 4. Qualitative Limitations of DT DT not always interpreted by patients Distress not always understood by patients There is no anchor Patients who are angry or depressed may not say “distressed” But some patients may not interpret “depression”
  5. 5. Quantitative Limitations of DT Of 401 chemotherapy attendees 59% have an emotional complication (3v4) 37% (62% of 59%) it included distress 23% it excluded distress Validity of DT vs depression (DSMIV) SE 80% SP 60% PPV 32% NPV 93%
  6. 6. Phase II
  7. 7. ET - Table of Cut-Points Distress Anxiety Depression Anger Help Thermomete thermomet Thermomete Thermomete Thermomete r er r r r Cut-point Insignifica nt 39.0 25.6 50.1 55.7 54.3 0,1 Minimal 20.1 22.5 18.3 13.6 15.4 2,3 Mild 16.9 16.5 12.2 10.5 12.2 4,5 Moderate 12.0 14.5 9.8 6.6 6.6 6,7 Severe 11.9 20.8 9.5 13.6 11.2 8,9,10 p130
  8. 8. 1.00 0.90 0.80 Ten 0.70 Nine Eight 0.60 Seven Six 0.50 Five Four 0.40 Three Two 0.30 One 0.20 Zero 0.10 0.00 Distress Anxiety Depression Anger Thermometer Thermometer Thermometer Thermometer
  9. 9. DepT DT 23% 37% 4% 3% 3% DT DepT 7% 1% Non-Nil 8% 0% Nil 9% 59% 41% 4% 1% AnxT 2% AngT 15% 2% AnxT AngT 47% 18%
  10. 10. Phase II
  11. 11. Top 10 patient concerns 1 Anxiety 312 2 Family concerns 157 3 Independence/Role 122 4 Appearance 111 5 Pain 86 6 Sleep 76 7 Fatigue/Energy 71 8 Finances 63 9 Weight 52 10 Breathing 49
  12. 12. Concerns linked with distress t = 7.705129 P < 0.0001 Anxiety t = 4.859186 P < 0.0001 depression/hopeless t = 4.448083 P < 0.0001 Family concerns/issues t = 4.10916 P < 0.0001 Anger/Irritability t = 2.699969 P = 0.0073 Self-Esteem t = 2.69652 P = 0.0073 Cancer worries t = 2.497361 P = 0.013 Coping concerns t = 2.371534 P = 0.0183 Sleep
  13. 13. Validity of the ET
  14. 14. Vs DT DepT HADS-A AUC: DT=0.82 DepT=0.84 AnxT=0.87 AnxT AngT AngT=0.685
  15. 15. Graphical – Screening principles # of Cut-Off Individuals Low High Non-Depressed <<<< low Specificity Severity of Depression High Sensitivity >>>> Depressed # of Individuals
  16. 16. Validity Against HADS-T (distress) We analysed data collected from Leicester Cancer Centre from 2007-2009 The researcher applied the HADS and used a HADS-T >14 to signify distress. We collated full data on 660 patient assessments
  17. 17. HADS-T In the parent sample of 660: SE SP AUC CUT DT – 71.9% 78.4% 0.814 cut point =4
  18. 18. HADS-T In the parent sample of 660: SE SP AUC CUT DT – 71.9% 78.4% 0.814 cut point =4 AnxT – 75.7% 73.4% 0.821 cut point =5 DepT – 77.6% 82.2% 0.855 cut point =3 AngT – 77.5% 77.6% 0.823 cut point =2 HelpT - 69.1% 80.8% 0.809 cut point =3
  19. 19. Against MDD The researcher applied criteria for MDD. We collated full data on 660 patient assessments MDD was defined by DSMIV criteria (5 of 9 symptoms) 12.9% had MDD and 14.8% were from ethnic minorities (largely British South Asian of India descent).
  20. 20. Validity vs MDD - Results SENSITIVITY SPECIFICITY AUC DT – 82.4% 68.6% 0.811
  21. 21. Validity vs MDD - Results SENSITIVITY SPECIFICITY AUC DT – 82.4% 68.6% 0.811 AnxT – 85.9% 56.2% 0.774 DepT – 80.0% 78.2% 0.853 AngT – 83.5% 66.1% 0.782 HelpT - 68.2% 79.1% 0.799
  22. 22. Whole Sample vs MDD 100.00% Sensitivity 90.00% Specificity 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% DT – AnxT – DepT – AngT – HelpT -
  23. 23. Validity vs MDD – 15% minorities SENSITIVITY SPECIFICITY AUC DT BSA - 100% 56.9% 0.827 AnxT BSA - 72% 72.1% 0.730 DepT BSA - 80.0% 69.4% 0.770 AngT BSA - 84.0% 65.3% 0.782 HelpT BSA - 92% 56.9% 0.791
  24. 24. BSA vs MDD 100% Sensitivity 90% Specificity 80% 70% 60% 50% 40% 30% 20% 10% 0% DT – AnxT – DepT – AngT – HelpT -
  25. 25. Summary Against Distress All thermometers were “good” but DepT was best Against Depression (all) DepT > DT were “good” Against Depression in BSA DT may be best?

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