This study aimed to empirically define cut-points for mild, moderate, and severe distress using the Distress Thermometer (DT) scale by examining levels of daily functioning. The researchers analyzed data from over 1000 cancer patients in the UK assessing DT scores and levels of difficulty with daily activities. They found that average DT scores increased with greater functional impairment, from 2.1 for those unimpaired to 6.5 for those severely impaired. Based on these results, the researchers concluded that DT scores of 4-5 could indicate mild distress, 6-7 moderate distress, and 8-10 severe distress.

1. P1-52 - Defining Cut-Points for Mild, Moderate & Severe Distress using
Daily Functioning: Empirical Study using the Distress Thermometer
Alex J Mitchell Consultant in Psycho-oncology Karen Lord PhD Candidate & CNS Paul Symonds Reader in Oncology
Department of Cancer & Molecular Medicine, University Hospitals Leicester (UK) & University of Leicester ajm80@le.ac.uk
OBJECTIVES
There has been much research on the DT but current cut-offs are somewhat arbitrary. In 2007 the
NCCN suggested a cut-point of 4v5 for significant distress; in 2008 this was revised to 3v4. We
wished to clarify appropriate thresholds for significant distress as well as defining minimal, mild,
moderate and severe distress using the Distress Thermometer
METHODS
We analysed data collected from Leicester Cancer Centre from 2008-2009 involving approximately
1000 people approached by a research nurse and two therapeutic radiographers. Of those
approached we collected data on 738 presentations, that is people seen up to three times over 9
months during treatment for cancer. We had complete data regarding daily function from 416
assessments.
We examined daily function using the question “How difficult have these problems made it for you
to do your work, take care of things at home, or get along with other people?”
and used a scale of responses:
“0=Not difficult at all 1=Somewhat Difficult 2=Very Difficult 3=Extremely Difficult”
RESULTS
The mean DT score was 3.2 across all patients. We stratified DT scores by severity of functional
impairment. Relatively few people had moderately severe impairment (n=39; 7%) or severe
impairment (n=14; 2%).
The mean score for unimpaired was 2.1, for mildly impaired 4.1, moderately impaired 5.9 and
severely impaired 6.5. However there were wide standard deviations in all cases. This
suggests that a simplified scoring system that we previously suggested* might work well in
clinical practice
100% 0.02
0.00 0.00 0.00 0.00 0.00
0.03 0.04 0.03
0.01
The following table shows the rate of unimpaired vs impaired
0.06
0.08
0.09
0.07
0.17
function by DT score: 90%
0.18 0.11
0.28
0.19
0.20
0.31
0.18
80%
0.31
0.47
70% 0.20
Zero One Two Three Four Five Six Seven Eight Nine Ten
0.48
0.40
60%
Unimpaired 0.80 0.69 0.62 0.50 0.41 0.43 0.32 0.25 0.33 0.27 0.20 0.50
0.40 0.53
50% 0.45
1=Somewhat Difficult 0.18 0.31 0.31 0.47 0.48 0.40 0.40 0.53 0.50 0.45 0.40
40% 0.80 0.40
2=Very Difficult 0.01 0.00 0.08 0.03 0.07 0.11 0.28 0.19 0.17 0.18 0.20
0.69
0.62
30%
3=Extremely Difficult” 0.02 0.00 0.00 0.00 0.04 0.06 0.00 0.03 0.00 0.09 0.20
0.50
3=Extremely Difficult” 0.43
20% 0.41
2=Very Difficult 0.32
0.33
0.27
0.25
10% 1=Somewhat Difficult 0.20
Unimpaired
0%
CONCLUSIONS
Zero One Tw o Three Four Five Six Seven Eight Nine Ten
Using an assessment of function, we found that DT scores for mild (4-5), moderate (6-7) and
severe (8-10) might be clinically appropriate.
ACKNOLWEDGEMENT Acknowledgement: Funding from Hope against Cancer; thanks to Pfeizer
for use of the translated PHQ9
WEBSITE: www.psycho-oncology.info