The Distress Thermometer as an ultra-short screening tool: A first validation study for mixed-cancer outpatients in Singapore Haikel A. Lim a , Rathi Mahendran a,b, ⁎ , Joanne Chua b , Chao-Xu Peh a , Siew-Eng Lim c , Ee-Heok Kua a,b a Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 119228 Singapore b Department of Psychological Medicine, National University Hospital, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 119228 Singapore c National University Cancer Institute, Singapore, National University Health System, NUHS Tower Block, Level 7, 1E Kent Ridge Road, 119228, Singapore Abstract Introduction: Research has shown that single-item tools, like the Distress Thermometer (DT), are comparable to longer ones, like the Hospital Anxiety and Depression Scale (HADS). In this study, we tested the validity of the DT in a population of Singapore cancer outpatients, and determined the cut-off scores on the DT for clinically relevant distress and an impaired quality of life (QOL). We also documented the prevalence of anxiety, depression, and QOL impairments in this population. Methods: One hundred and five patients (Mdn age = 51–60 years, 64% female, and 71% Chinese) diagnosed with various cancers participated in this study. They completed a standard socio-demographic form, the DT and the Problem List, the HADS, and the EuroQOL Quality of Life Scale (EQ-5D). Results: Almost a third of patients had clinically significant emotional distress, with 15%–16% having probable levels of anxiety and depression. Almost half (41%–55%) had an impaired QOL compared to Singapore population norms. Receiver operating characteristic curve analyses identified an area under the curve of 0.89 (SE = 0.36, 95% CI [0.82, 0.96], p b .001) when compared to the HADS cut-off score of 15. A cut-off score of 5 on the DT had the best sensitivity (0.88) and specificity (0.81). Participants above the DT cut-off score of 5 reported significantly more emotional problems (worry, nervousness, depression, sadness), insurance/finance-related problems, and sleep problems. They also scored significantly lower on EQ-5D, with more QOL impairments in the domains of carrying out their usual activities and anxiety/depression. Conclusion: Levels of distress, anxiety, depression, and QOL impairments are high in this population. The DT was found to be a valid tool for distress screening in the Singapore cancer population, with a recommended cut-off score of 5. © 2014 Elsevier Inc. All rights reserved. 1. Introduction In Singapore, a small island state with a population of 5.3 million, one in three deaths is due to cancer; every day, 16 people die from [1], and 31 are diagnosed with [2], cancer. Undeniably, the diagnosis and treatment of cancer are life- changing events; patients with cancer suffer high levels of distress, experience elevated levels of anxiety and depression [3], and have a lowered quality of life (QOL). Medical teams very often focus on treating the illness, and in the process, may overlook patients’ emotional and psychosocial needs. 1.1. Emotional Distress and Quality of Life in Cancer Patients To the best of our knowledge, there is no published literature that documents the levels of anxiety, distress, and QOL in Singapore cancer patients; however, elsewhere in Asia, levels of distress in cancer patients are high. A study of Indonesian women with breast cancer reported a 52% prevalence rate for distress [4]. Studies in Japan found that 69% of breast cancer patients had significant emotional distress [5], and at least 37% of patients undergoing chemotherapy reported moderate or severe distress [6,7]. In Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 55 (2014) 1055 – 1062 www.elsevier.com/locate/comppsych ⁎ Corresponding author at: Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore 119228. Tel.: +65 6772 3893; fax: +65 6777 2191. E-mail address: pcmrathi@nus.edu.sg (R. Mahendran). 0010-440X/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2014.01.008