Understanding Distress Levels in Rural Cancer Patients

Introduction: Cancer diagnosis and treatment is a stressful process, with effects that have been compared to those seen in individuals who have experienced prolonged combat exposure (Smith, Redd, Peyser, & Vogl, 1999).  In response to these stressors, cancer patients and their families frequently contend with severe distress, as well as acute or posttraumatic stress, or partial posttraumatic stress symptoms (PTSS) (e.g. Varela, Ng, Mauch, & Recklitis, 2013).  The 2012 American College of Surgeons’ Commission on Cancer (CoC) guidelines require accredited treatment centers to integrate distress screening into standard care.  One of the most commonly used screening instruments is the NCCN Distress Thermometer (Rohan, 2012).  This short form measure consists of a single item zero-to-ten self-report measure of distress, as well as 39 dichotomous concern and problem questions.  Although frequently used, measures such as the Distress Thermometer are relatively new and future research should focus on its application in rural settings, as well as exploring the factors that influence reported levels of distress.

Methods:  Distress Thermometer surveys were collected from 158 patients at a small cancer center in a rural area of a southern state.  The assessments were collected during routine care.  Participants ranged in age from 36 to 101, with a mean age of 66 (SD=11.74). The sample consisted of 52.8% female patients and more than 99% of the sample was Caucasian.  Individual factors such as age, gender, employment status, and type of cancer were compared between those who indicated significant levels of distress and those who did not.

Results:  More than 40% of those surveyed reported a distress level of four or higher – the traditional cut score indicating significant levels of distress.  Distress levels differed significantly between types of cancer (χ²(7)=14.487, p=0.043).  Not surprisingly, all patients who were diagnosed with brain cancer reported significant levels of distress (χ²(46)=63.07, p=0.048).  Age was found to be related to clinical levels of distress Additionally, unemployed individuals were more likely to experience distress (χ²(2)=9.38, p=.0025).  Those who reported more individual psychosocial problem areas were also more likely to report significant levels of distress (χ²(24)=65.668 p<0.001).  There was not a significant difference associated with marital status, or between male and female patients. 

Implications: Severe levels of distress can complicate treatment and lead to severe psychosocial outcomes such as posttraumatic stress.  Understanding the factors that predispose cancer patients to distress is critical to connecting patients with needed resources and improving long-term psychosocial outcomes.