Screening for cancer-related distress: Summary of evidence from tools to programmes

INTRODUCTION: A number of studies have addressed the development and testing of tools for measuring cancer-related distress. Except for studies of diagnostic validity, knowledge on the effect of screening for psychological distress on psychological well-being is limited. We aimed to describe and critically discuss the findings of randomized trials of the effect of screening and to identify components necessary for future studies of the effectiveness of screening programmes.

METHODS: A search was made of the Embase/Medline and Web of Knowledge abstract databases from inception to September 2010. Our inclusion criterion was randomized controlled trials concerning the effect of screening for psychological distress on psychological outcomes. We compared the randomized trials on the following aspects: design and methods, setting and sample, screening and intervention, effects on psychological distress, staff utilization of screening results, possible confounding factors and other methodological limitations.

RESULTS: Of the seven identified randomized trials of the effect of screening for psychological distress, three showed an effect on psychological well-being, one showed an effect only among patients depressed at baseline, and three studies showed no effect. Several of the trials had methodological weaknesses and they were heterogeneous in design and content making direct comparisons difficult.

DISCUSSION: Future randomized trials are needed to examine comparative validity of different screening approaches and to evaluate the benefits of screening linked with associated treatment. Trials should include distress as a patient outcome, use appropriate samples, include a detailed, theory-based distress management plan, offer staff training and ideally track staff and patient use of subsequent interventions. Provisional work suggests that screening for psychological distress holds promise and is often clinically valuable, but it is too early to conclude definitively that psychological screening itself affects the psychological well-being of cancer patients.