Psycho-Oncology Psycho-Oncology 19: 1313–1320 (2010) Published online 29 January 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.1697 Psychological distress in patients with pancreatic cancer—an understudied group Karen L. Clark 1Ã , Matthew Loscalzo 1 , Peter C. Trask 2 , James Zabora 3 and Errol J. Philip 4 1 Sheri and Les Biller Patient and Family Resource Center, City of Hope, Duarte, CA, USA 2 Outcomes Research, Pfizer Inc., New London, CT, USA 3 National Catholic School of Social Service, The Catholic University of America, Washington, DC, USA 4 University of Notre Dame, Notre Dame, IN, USA Abstract Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States, unsuccessful in significantly improving 5-year survival. A diagnosis of pancreatic cancer may be associated with increased psychological distress, yet remarkably little is known about the degree of psychological distress experienced by these patients at the time of diagnosis and treatment. Method: In a cross-sectional study, 304 patients with pancreatic cancer and 7749 patients with other cancer diagnoses completed the Brief Symptom Inventory (BSI) or the Brief Symptom Inventory-Shortened Version (BSI-18) and the Problem Common Checklist (PCL) during outpatient registration. Sociodemographic characteristics were collected from patients’ clinical files. Results: A higher percentage of pancreatic cancer patients reported elevated distress across each subscale of the BSI and BSI-18 when compared with those diagnosed with other cancer diagnoses as a group. The most notable difference was established on the depression subscale, with 28.8% of pancreatic patients reporting elevated depression compared with 18.5% of other cancer diagnoses. In pancreatic patients, a significant difference was also found in the percentage of males endorsing high depression levels when compared with females (34.0 vs 22.6%, po0.05). Conclusions: Pancreatic cancer patients demonstrate elevated levels of psychological distress. This should alert providers to be vigilant in evaluating patients for distress and to provide appropriate referrals. The endorsement of fatigue and pain, along with the observed gender differences, suggest that early distress management interventions may need to include components targeted to these issues. Copyright r 2010 John Wiley & Sons, Ltd. Keywords: pancreatic cancer; psychosocial; distress; BSI; gender; depression Introduction Within the past decade, the importance of under- standing, and subsequently treating, the emotional distress that can accompany a diagnosis of cancer has been increasingly recognized. This realization has led to a variety of screening approaches designed to match patients with the greatest need to the services best suited to care for those needs. For many, this screening occurs at, or shortly near, the time of the patient’s diagnosis or first interac- tion with the cancer center. Individuals with pancreatic cancer are one of the high-risk groups that need psychosocial ser- vices. Despite its history and current standing as the fourth leading cause of cancer-related death in the United States [1,2] there is remarkably little known about the degree of psychological distress experienced by these patients at the time of diagnosis. Literature reviews and clinical studies of depres- sion and anxiety in individuals with cancer have suggested that both issues are present in the majority of patients at some point during the cancer trajectory [3–9]. In individuals with pancrea- tic cancer, early studies reported that depression- related symptoms could be identified in 71% of patients [10]. Holland et al. [11] found that advanced pancreatic cancer patients reported sig- nificantly higher levels of psychological distress than patients with other types of advanced abdom- inal neoplasms. In contrast, more recent studies employing self-report measures, such as the Edmonton Symptom Assessment Scale (ESAS), have noted relatively low levels of depression and anxiety in pancreatic cancer patients [12]. Relatively * Correspondence to: Sheri and Les Biller Patient and Family Resource Center, 1500 East Duarte Road, Duarte, CA. 91010-3000, USA. E-mail: kclark@coh.org Received: 12 August 2009 Revised: 25 November 2009 Accepted: 9 December 2009 Copyright r 2010 John Wiley & Sons, Ltd.