High level of distress in long-term survivors of thyroid carcinoma: Results of rapid screening using the distress thermometer

Figures & data

Table I. Patient characteristics and relation to distress thermometer (DT) score.

			Correlation to DT score
		%	Spearman's-rho	p-value
Gender (n): male/female	38/107		0.145	0.09
Age: mean (SD) (years)	51.7 (13.8)		−0.054	0.531
Age at diagnosis: mean (SD) (years)	40.1 (13.1)		−0.059	0.497
Duration since diagnosis: median (range) (years)	8.8 (0–41)		0.081	0.349
<1 year: n (%)	8 (5.5)
1–5 year: n (%)	29 (20.0)
5–10 year: n (%)	44 (30.3)
>10 year: n (%)	64 (44.1)
Follow-up since last treatment: median (range) (years)	7.2 (0–41)		0.036	0.676
Histopathological subtype: (n)
Papillary	106	73.1	−0.123	0.151
Folliculary	36	24.8	0.127	0.138
Mixed	3	2.1	0	0.994
TNM classification* stage: (n)			−0.094	0.292
I	68	46.9
II	22	15.2
III	11	7.6
IV	33	22.7
Unknown	11	7.6
Surgical treatment: (n)
Hemithyroidectomy	3	2.8	−0.128	0.14
Total thyroidectomy	140	96.6	0.052	0.55
Lymph node dissection	50	34.5	−0.133	0.125
Unknown	2	1.4
RAI treatment:
Number of treatments
0	12	8.3	0.067	0.437
1	76	52.4
2	37	25.5
>2	19	13.1
Unknown	1	0.7
Cumulative dose of I^131:
0 mCi	12	8.3	0.055	0.525
<100 mCi	6	4.1
100–200 mCi	70	48.3
>200 mCi	55	37.9
Unknown	2	1.4
Complications of surgery: (n)
Hypoparathyroidism (permanent)	43	29.7	0.134	0.118
Recurrent laryngeal nerve paralysis	8	5.5	0.023	0.786
No complications	95	65.5	−0.141	0.101
Disease status: (n)
Remission	110	80.3	0.054	0.533
Active disease	27	19.7
Mean TSH at last follow-up: (IU/L) (SD)	0.4 (1.1)		0.061	0.486

*UICC TNM Classification of malignant tumors, 6th edition [43].

Table II. Problem list (PL) items and correlation to distress thermometer (DT) score (*n represents the number of patients reporting a specific problem in the total group and in the active disease group).

				Correlation of total group PL score to total group DT score
Problem list	Mean score (SD)	n* (Total/active disease)	% (Total/active disease)	Spearman's-rho	p-value
Overall number of problems	9.5 (8.3)			0.827	<0.001
Practical problems	0.9 (1.3)			0.715	<0.001
Child care		13/2	9.0/7.4
Housing		8/1	5.5/3.7
House holding		41/6	28.3/22.2
Transportation		9/1	6.2/3.7
Work/school		35/9	24.1/33.3
Financial		18/4	12.4/14.8
Insurance		8/1	5.5/3.7
Social problems	0.4 (0.8)			0.468	<0.001
Dealing with partner		27/3	18.6/11.1
Dealing with children		20/4	13.8/14.8
Dealing with friends/relative		18/3	12.4/11.1
Emotional problems	2.5 (2.8)			0.652	<0.001
Grip on emotions		47/4	32.4/14.8
Memory		47/11	32.4/40.7
Confidence		35/4	24.1/14.8
Fears		31/4	21.4/14.8
Sadness		40/7	27.6/25.9
Nervousness		58/9	40.0/33.3
Loneliness		20/2	13.8/7.4
Concentration		51/8	35.2/29.6
Feeling of guilt		21/2	14.5/7.4
Loss of control		24/6	16.6/22.2
Spiritual-religious problems	0.2 (0.5)			0.233	0.006
Meaning of life		16/1	11.0/3.7
Faith in god/religion		13/5	9.0/18.5
Physical problems	5.3 (4.5)			0.782	<0.001
Appearance		22/5	15.2/18.5
Changes in urination		12/3	8.3/11.1
Constipation		23/2	15.9/7.4
Diarrhea		12/3	8.3/11.1
Eating		23/5	15.9/18.5
Feeling swollen		35/8	24.1/29.6
Fever		1/0	0.7/0.0
Mouth sores		18/8	12.4/29.6
Nausea		16/3	11.0/11.1
Nose dry/congested		38/4	26.2/14.8
Pain		35/5	24.1/18.5
Sexuality		25/4	17.2/11.1
Skin dry/itchy		42/5	29.0/18.5
Sleep		60/9	41.4/33.3
Breathing		17/2	11.7/7.4
Vertigo		28/4	19.3/14.8
Speech		17/3	11.7/11.1
Taste		14/5	9.7/18.5
Weight changes		46/11	31.7/40.7
Paresthesia in hands/feet		46/14	31.7/51.9
Washing/dressing		3/1	2.1/3.7
Getting around		26/5	17.9/18.5
Fatigue		90/15	62.1/55.6
Physical fitness		68/8	46.9/29.6
Muscle strength		58/5	40.0/18.5

Table III. Hospital anxiety and depression scale (HADS) and illness cognition questionnaire (ICQ) scores and correlation to distress thermometer (DT) scores (*n represents the number of patients with a score above the mentioned threshold).

		Correlation to DT score
		Spearman's-rho	p-value
HADS
Total	Mean score=9.2	0.611	<0.001
	SD=7.7
≥15 [n* (%)]	32 (22.1%)
Anxiety	Mean score=5.4	0.547	<0.001
	SD=4.3
≥8 [n* (%)]	36 (24.8%)
Depression	Mean score=3.8	0.602	<0.001
	SD=3.9
≥8 [n* (%)]	28 (19.3%)
ICQ
Helplessness	Mean score=9.0	0.662	<0.001
	SD=3.6
Acceptance	Mean score=19.0	−0.544	<0.001
	SD=4.2
Disease benefits	Mean score=16.1	−0.092	0.285
	SD=4.5

Figure 1. Receiver operating characteristics (ROC) curve of distress thermometer (DT) scores versus hospital anxiety and depression scale (HADS) cut-off scores. AUC 0.82, SD 0.043, 95% CI 0.739–0.906, p < 0.001.

Table IV. Frequencies, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of distress thermometer (DT) scores (*n represents the number of patients with the respective score in the total group and in the group of patients with active disease).

DT score	n* (cum.%) Total group	n* (cum.%) Active disease	Sensitivity	Specificity	PPV	NPV
0	26 (19.1)	6 (22.2)	1.00	0.00	0.22	0.00
1	18 (32.4)	5 (40.7)	0.97	0.24	0.26	0.96
2	17 (44.9)	1 (44.4)	0.97	0.41	0.32	0.98
3	15 (55.9)	4 (59.3)	0.90	0.55	0.36	0.95
4	13 (65.4)	4 (74.1)	0.80	0.66	0.40	0.92
5	12 (74.3)	0 (74.1)	0.77	0.77	0.49	0.92
6	12 (83.1)	3 (85.2)	0.60	0.84	0.51	0.88
7	13 (92.6)	3 (96.3)	0.50	0.92	0.65	0.87
8	7 (97.8)	1 (100.0)	0.20	0.96	0.60	0.81
9	2 (99.3)	0 (100.0)	0.07	0.99	0.67	0.77
10	1(100.0)	0 (100.0)	0.04	1.00	1.00	0.79

UICC TNM Classification of malignant tumors, 6th edition. Hoboken, New Jersey: John Wiley & Sons; 2002.

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