title: Screening for psychological distress in surgical breast cancer patients.
abstract: BACKGROUND
  This pilot study assessed the levels of patient emotional distress and impact on clinic throughput time.
  
  
  METHODS
  From April through August 2012, 149 breast cancer patients at the Penn State Hershey Breast Center were screened with the emotions thermometer (ET), a patient-rated visual 0-10 scale that measures distress, anxiety, depression, anger, burden, and need for help. Also, patients indicated their most pressing cancer-related concerns. Clinic visit time was computed and compared with a control group.
  
  
  RESULTS
  Using a previously validated cut point ≥4 for any thermometer, we found emotional difficulty in the following proportions: distress 22 %, anxiety 28 %, depression 18 %, anger 14 %, burden 16 %, and need for help 10 %; 35 % scored above the cut point on at least 1 thermometer. We found higher levels of distress in all domains associated with younger age at diagnosis. More extensive surgery (bilateral mastectomy vs unilateral mastectomy vs. lumpectomy) was correlated with higher levels of psychosocial distress. Most often cited concerns, experienced by >20 %, included eating/weight, worry about cancer, sleep problems, fatigue, anxiety, and pain. Mean clinic visit time for evaluable patients screened using the ET (n = 109) was 43.9 min (SD 18.6), compared with 42.6 min (SD 16.2) for the control group (n = 50).
  
  
  CONCLUSIONS
  Utilizing the ET, more than one-third of women screened met criteria for psychological distress. Younger age at diagnosis and more extensive surgery were risk factors. The ET is a simple validated screening tool that identifies patients in need of further psychological evaluation without impacting clinic throughput time.
authors.affiliation: Department of Surgery, Medicine and Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA, jschubart@hmc.psu.edu.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.forename: Matthew
authors.initials: M
authors.lastname: Emerich
authors.forename: Michelle
authors.initials: M
authors.lastname: Farnan
authors.forename: J
authors.initials: J
authors.lastname: Stanley Smith
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Kauffman
authors.forename: Rena B
authors.initials: RB
authors.lastname: Kass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006801:Humans; D008403:Mass Screening; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010414:Pennsylvania / Q000453:epidemiology; D010865:Pilot Projects; D011379:Prognosis; D011594:Psychometrics; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires