Emotion Thermometers Tool©

Objective: Physiological and psychological sequelae are frequent after a cancer diagnosis and also on the long term. Screening could help detect psychological distress early and thus enable timely provision of adequate treatment. The emotion thermometer (ET) is a validated screening tool including five dimensions (distress, anxiety, depression, anger, and need-for-help). Reviewing the literature, we aimed to describe (a) the validity and (b) the application of the ET.

Methods: Six databases were systematically searched for studies using the ET in individuals diagnosed with cancer. Included studies were critically appraised for methodological quality. ET validity and application were narratively synthesized.

Results: We identified 580 records eligible for title-abstract screening. Seventeen studies based on 13 different populations were included. Validation studies (5 of 17) concluded that the ET is sensitive to distress detection, delivering prompt and accurate results with no negative impact on clinic visit time. Furthermore, its use is accepted in patients and clinicians. The remaining 12 exploratory studies applied the ET for screening purposes (3 of 12), as outcome measure (6 of 12), or as predictor variable measure (3 of 12). Most studies were conducted in Europe (11 of 17), and 7 of the 12 exploratory studies used the recommended cutoff (≥4). Study populations were mostly female (9 of 13) with a mean age greater than 50 years (12 of 13) at study.

Conclusions: Publications on distress screening with the ET are scarce, especially among young populations. However, research and studies' recommendations support the ET's utility as a valid and feasible tool for distress screening including anxiety and depression and suggest its implementation as part of a structured program for early screening in cancer care.

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).

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 (MINI) tools.

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.

Purpose: The 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 the ET.

Methods: A representative sample of the adult German general population (N = 2437) completed the ET, the PHQ-4, the FACIT-fatigue scale, and the demoralization scale.

Results: The 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).

Conclusions: The 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.