(full papers published in Psycho-oncology
2010 Feb;19(2):125-33 and
2010 Feb;19(2):134-140 and http://onlinelibrary.wiley.com/doi/10.1111/ajco.12180/abstract)
In our study in the Leicester Cancer Centre, 11.5%
of people scored three or below on all ET domains and 69.3% scored four or above
on at least one domain. Of low scorers on the DT about 50% recorded emotional
difficulties on the new Emotion Thermometers (ET) tool, suggesting added value
beyond the Distress thermometer (DT) alone. Using a cut-off of 3v4 on all
thermometers against the total HADS score (cut-off 14v15), the optimal
thermometer was the AngT (sensitivity 89% specificity 46%). Against HADS Anxiety
scale (cut-off 7v8), and judging by the Predictive Summary Index, the optimal
thermometer was AnxT (sensitivity 92% specificity 61%). Against the HADS
depression scale, the optimal thermometer was the depression thermometer
(sensitivity 60% specificity 78%). Finally, against the DSM-IV diagnosis of
major depression the optimal thermometer was the depression thermometer
sensitivity 80% specificity 79%) but no single method had good positive
predictive value (PPV). Further improvements can be made by adjusting the
cut-offs particularly for detection of anxiety (AnxT ROC = 0.867 at a cut-off of
5v6) and detection of depression (DepT ROC = 0.751 at a cut-off 4v5).
Beck KR, Tan
SM, Lum SS, Lim LE, Krishna LK. Validation of the emotion thermometers and
hospital anxiety and depression scales in Singapore: Screening cancer patients
for distress, anxiety and depression. Asia Pac J Clin Oncol. 2014 Mar 27. doi:
Aim To validate the emotion thermometer (ET)
and hospital anxiety and depression scales (HADS) in Singapore, screening cancer
patients for distress, anxiety and depression. Methods Three hundred
fifteen cancer patients from National Cancer Centre and Singapore General
Hospital participated in the study. Interviews and assessments were conducted in
English, assessing patients' sociodemographic data and screening for emotional
symptoms using the ET, HADS and Mini-International Neuropsychiatric Interview
Results Fifty-three patients (16.83%)
fulfilled the MINI criteria for major depressive disorder and 30 patients
(12.77%) for generalized anxiety disorder. The ET depression thermometer
correlated positively with HADS depression subscale, r?=?0.645 (P?<?0.01),
with area under curve (AUC) value being 0.76, when cutoff score is 3. The ET
anxiety thermometer correlated positively with HADS anxiety subscale, r?=?0.632
(P?<?0.01), with an AUC value of 0.76, when cutoff score is 4. The ET
distress thermometer correlated positively with HADS depression subscale,
r?=?0.506 (P?<?0.01), with AUC value being 0.72, when cutoff score is 2, the
ET distress thermometer also correlated positively with HADS anxiety subscale,
r?=?0.652 (P?<?0.01), with the AUC value being 0.77, when cutoff score is 4.
Using MINI diagnoses for anxiety and depression as the gold standard, cutoff
score for HADS depression scale is 7, which yielded an AUC of 0.826. The cutoff
score for HADS anxiety scale is 5, yielding an AUC of 0.779.
Conclusion Results from the study support the
use of both ET and HADS as valid and reliable instruments assessing for
distress, anxiety and depression in cancer patients.
Screening for Psychological
Distress in Surgical Breast Cancer Patients Jane R. Schubart PhD, MS, MBA,
Matthew Emerich BS, Michelle Farnan RN, MSN, OCN, J. Stanley Smith MD, Gordon L.
Kauffman MD, Rena B. Kass MD Breast Oncology Volume 21, Issue 10 / October ,
pilot study assessed the levels of patient emotional distress and impact on
clinic throughput time.
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.
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).
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.
Normative values for the distress
thermometer (DT) and the emotion thermometers (ET), derived from a German
general population sample
Quality of Life Research January
2019, Volume 28, Issue 1, pp 277–282
distress thermometer (DT) and the emotion thermometers (ET) are short
screening instruments for use in oncological practice. The aim of this study
was to provide normative values and to analyze the correlational structure of
representative sample of the adult German general population
(N = 2437) completed the ET, the PHQ-4, the FACIT-fatigue scale,
and the demoralization scale.
percentages of people above the cutoff (≥ 4) and the mean scores
of the five ET scales were as follows: distress: 39.0%, M = 3.15 ± 2.62,
anxiety: 12.3%, M = 1.36 ± 1.93, depression:
16.1%, M = 1.65 ± 2.11, anger: 24.5%, M = 2.33 ± 2.16,
and need for help: 10.7%, M = 1.18 ± 1.90. Women
reported significantly higher levels of burden than men, with effect sizes
between 0.07 (anger) and 0.36 (anxiety). All ET dimensions were interrelated
(r between 0.44 and 0.69) and significantly correlated with the other
scales (r between 0.36 and 0.68).
normative scores can help qualify assessments of groups of patients. The new
four dimensions of the ET provide relevant additional information that is not
already covered by the DT.
We have published a series of posters on the ET at
the IPOS and APOS conferences 2010-2014.
IPOS2010 Poster 130 (defining ET thresholds)
IPOS2010 Poster 131 (defining ET reliability)
IPOS2010 Poster 131 (ET re-validation)
APOS2011 Poster 153 (ET validation vs depression)
IPOS2014 Poster 605 (ET large validation vs
IPOS2016 Poster 450 (ET validation vs anxiety
IPOS2016 Talk 416 (ET correlation with unmet needs
The tool is subject to copyright (c) Alex J Mitchell
but freely available (royalty free) for non-commercial and clinical use.
If this (or related) tools are useful please
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