Alex Mitchell www.psycho-oncology.info

Paul SymondsLorraine GraingerElena Baker-Glenn

Department of Cancer & Molecular Medicine, Leicester Royal Infirmary

IPOS 2010

T276 - A Large Scale Validation of the Emotion Thermometers as a Screening Tool for MDD & Distress in an Ethnically Diverse Cancer Population

T276 - A Large Scale Validation of the Emotion Thermometers as a Screening Tool for MDD & Distress in an Ethnically Diverse Cancer Population

Audit / Research Protocol

Phase I – DT across LNR network (incl training)

Phase II – Enhancements to DT

Phase III - Screening plus Intervention

Phase I

Qualitative Limitations of DT

DT not always interpreted by patients

Distress not always understood by patients

There is no anchor

Patients who are angry or depressed may not say “distressed”

But some patients may not interpret “depression”

Quantitative Limitations of DT

Of 401 chemotherapy attendees

59% have an emotional complication (3v4)

37% (62% of 59%) it included distress

23% it excluded distress

Validity of DT vs depression (DSMIV)

SE 80% SP 60% PPV 32% NPV 93%

Phase II

ET - Table of Cut-Points

11.2

6.6

12.2

15.4

54.3

Help Thermometer

8,9,1013.69.520.811.9Severe

6,76.69.814.512.0Moderate

4,510.512.216.516.9Mild

2,313.618.322.520.1Minimal

0,155.750.125.639.0Insignificant

Cut-point

Anger Thermometer

Depression Thermometer

Anxiety thermometer

Distress Thermometer

p130

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

DistressThermometer

AnxietyThermometer

DepressionThermometer

AngerThermometer

TenNineEightSevenSixFiveFourThreeTwoOneZero

8%

DT37%

DepT23%

AngT18%

AnxT47%

4%

7%

1%

1%

9%

3%

0%

2%

4%

15%

3%

2%

Nil41%

Non-Nil59%

DT

AnxT AngT

DepT

Phase II

Top 10 patient concerns

49Breathing1052Weight963Finances871Fatigue/Energy776Sleep686Pain5

111Appearance4

122Independence/Role3

157Family concerns2

312Anxiety1

Concerns linked with distress

SleepP = 0.0183t = 2.371534

Coping concernsP = 0.013t = 2.497361

Cancer worriesP = 0.0073t = 2.69652

Self-EsteemP = 0.0073t = 2.699969

Anger/IrritabilityP < 0.0001t = 4.10916

Family concerns/issuesP < 0.0001t = 4.448083

depression/hopelessP < 0.0001t = 4.859186

AnxietyP < 0.0001t = 7.705129

Validity of the ET

DT DepTVsHADS-A

AnxT AngT

AUC:DT=0.82DepT=0.84AnxT=0.87AngT=0.685

Graphical – Screening principles

Non-Depressed

Depressed

# ofIndividuals

Cut-Off

# ofIndividuals

Severity of Depression

HighLow

High Sensitivity >>>>

<<<< low Specificity

Validity Against HADS-T (distress)

We analysed data collected from Leicester Cancer Centre from 2007-2009

The researcher applied the HADS and used a HADS-T >14 to signify distress.

We collated full data on 660 patient assessments

HADS-T

In the parent sample of 660:

SE SP AUC CUTDT – 71.9% 78.4% 0.814 cut point =4

HADS-T

In the parent sample of 660:

SE SP AUC CUTDT – 71.9% 78.4% 0.814 cut point =4

AnxT – 75.7% 73.4% 0.821 cut point =5

DepT – 77.6% 82.2% 0.855 cut point =3

AngT – 77.5% 77.6% 0.823 cut point =2

HelpT - 69.1% 80.8% 0.809 cut point =3

Against MDD

The researcher applied criteria for MDD. We collated full data on 660 patient assessments

MDD was defined by DSMIV criteria (5 of 9 symptoms)

12.9% had MDD and 14.8% were from ethnic minorities (largely British South Asian of India descent).

Validity vs MDD - Results

SENSITIVITY SPECIFICITY AUC

DT – 82.4% 68.6% 0.811

Validity vs MDD - Results

SENSITIVITY SPECIFICITY AUC

DT – 82.4% 68.6% 0.811

AnxT – 85.9% 56.2% 0.774

DepT – 80.0% 78.2% 0.853

AngT – 83.5% 66.1% 0.782

HelpT - 68.2% 79.1% 0.799

Whole Sample vs MDD

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

DT – AnxT – DepT – AngT – HelpT -

SensitivitySpecificity

Validity vs MDD – 15% minorities

SENSITIVITY SPECIFICITY AUC

DT BSA - 100% 56.9% 0.827

AnxT BSA - 72% 72.1% 0.730

DepT BSA - 80.0% 69.4% 0.770

AngT BSA - 84.0% 65.3% 0.782

HelpT BSA - 92% 56.9% 0.791

BSA vs MDD

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

DT – AnxT – DepT – AngT – HelpT -

SensitivitySpecificity

Summary

Against Distress

All thermometers were “good” but DepT was best

Against Depression (all)

DepT > DT were “good”

Against Depression in BSA

DT may be best?