title: The Distress Thermometer for screening for severe fatigue in newly diagnosed breast and colorectal cancer patients.
abstract: Internationally, the Distress Thermometer and associated Problem List are increasingly used in oncology as screening tools for psychological distress. Cancer-related fatigue is common but often overlooked in clinical practice. We examined if severe fatigue in cancer patients can be identified with the fatigue item of the Problem List.
  
  
  
  Newly diagnosed breast (N = 334) and colorectal (N = 179) cancer patients were screened for severe fatigue, which was defined as having a positive score on the fatigue item of the Problem List. The Fatigue Severity subscale of the Checklist Individual Strength was used as gold standard measure for severe fatigue.
  
  
  
  In total, 78% of breast cancer patients and 81% of colorectal cancer patients were correctly identified with the fatigue item. The sensitivity was 89% in breast cancer patients and 91% in colorectal cancer patients. The specificity was 75% in breast cancer patients and 77% in colorectal cancer patients. The positive predictive value was 53% in breast cancer patients and 64% in colorectal cancer patients, whereas the negative predictive value was 95% in both tumor types.
  
  
  
  The fatigue item of the Problem List performs satisfactorily as a quick screening tool for severe fatigue. However, a positive screen should be followed up with a more thorough assessment of fatigue, ie, a questionnaire with a validated cutoff point. Given time pressure of clinicians, this already implemented and brief screening tool may prevent severe fatigue from going undetected in clinical practice.
authors.affiliation: Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: H J G
authors.initials: HJG
authors.lastname: Abrahams
authors.affiliation: Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M F M
authors.initials: MFM
authors.lastname: Gielissen
authors.affiliation: Department of Medical Psychology, Hospital Gelderse Vallei, Ede, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Lugt
authors.affiliation: Department of Education and Training, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: E F W
authors.initials: EFW
authors.lastname: Kleijer
authors.affiliation: Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
authors.forename: W K
authors.initials: WK
authors.lastname: de Roos
authors.affiliation: Department of Medical Oncology, Hospital Gelderse Vallei, Ede, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Balk
authors.affiliation: Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: C A H H V M
authors.initials: CAHHVM
authors.lastname: Verhagen
authors.affiliation: Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, Nijmegen, The Netherlands.|Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Knoop
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology*; D057189:Checklist; D015179:Colorectal Neoplasms / Q000523:psychology*; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis; D011795:Surveys and Questionnaires
keywords: Distress Thermometer; cancer; fatigue; oncology; psychometric properties; screening