NCCN Guidelines® Insights: Distress Management, Version 2.2023

Featured Updates to the NCCN Guidelines

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Michelle B. Riba University of Michigan Rogel Cancer Center

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Kristine A. Donovan Moffitt Cancer Center

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Kauser Ahmed UCLA Jonsson Comprehensive Cancer Center

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Barbara Andersen The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute

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IIana Braun Dana-Farber/Brigham and Women’s Cancer Center

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William S. Breitbart Memorial Sloan Kettering Cancer Center

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Benjamin W. Brewer University of Colorado Cancer Center

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Cheyenne Corbett Duke Cancer Institute

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Jesse Fann Fred Hutchinson Cancer Center

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Stewart Fleishman Consultant

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Sofia Garcia Robert H. Lurie Comprehensive Cancer Center of Northwestern University

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Donna B. Greenberg Massachusetts General Hospital Cancer Center

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George F. Handzo Rev. Consultant

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Laura Herald Hoofring The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

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Chao-Hui Huang O’Neal Comprehensive Cancer Center at UAB

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Sean Hutchinson UT Southwestern Simmons Comprehensive Cancer Center

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Shelley Johns Indiana University Melvin and Bren Simon Comprehensive Cancer Center

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Jennifer Keller Fox Chase Cancer Center

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Pallavi Kumar Abramson Cancer Center at the University of Pennsylvania

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Sheila Lahijani Stanford Cancer Institute

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Sara Martin Vanderbilt-Ingram Cancer Center

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Shehzad K. Niazi Mayo Clinic Cancer Center

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Megan Pailler Roswell Park Comprehensive Cancer Center

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Francine Parnes Patient Advocate

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Vinay Rao Yale Cancer Center/Smilow Cancer Hospital

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Jaroslava Salman City of Hope National Medical Center

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Eli Scher Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

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Jessica Schuster University of Wisconsin Carbone Cancer Center

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Melissa Teply Fred & Pamela Buffett Cancer Center

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Angela Usher UC Davis Comprehensive Cancer Center

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Alan D. Valentine The University of Texas MD Anderson Cancer Center

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Jessica Vanderlan Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Megan S. Lyons National Comprehensive Cancer Network

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Nicole R. McMillian National Comprehensive Cancer Network

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Susan D. Darlow National Comprehensive Cancer Network

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These NCCN Guidelines for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. All patients experience some level of distress associated with a cancer diagnosis and the effects of the disease and its treatment regardless of the stage of disease. Clinically significant levels of distress occur in a subset of patients, and identification and treatment of distress are of utmost importance. The NCCN Distress Management Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights describe updates to the NCCN Distress Thermometer (DT) and Problem List, and to the treatment algorithms for patients with trauma- and stressor-related disorders.

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  • 1.

    Holland JC, Lazenby M, Loscalzo MJ. Was there a patient in your clinic today who was distressed? J Natl Compr Canc Netw 2015;13:10541056.

  • 2.

    Ma X, Zhang J, Zhong W, et al. The diagnostic role of a short screening tool—the distress thermometer: a meta-analysis. Support Care Cancer 2014;22:17411755.

  • 3.

    Chambers SK, Zajdlewicz L, Youlden DR, et al. The validity of the distress thermometer in prostate cancer populations. Psychooncology 2014;23:195203.

  • 4.

    Deng YT, Zhong WN, Jiang Y. Measurement of distress and its alteration during treatment in patients with nasopharyngeal carcinoma. Head Neck 2014;36:10771086.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Grassi L, Johansen C, Annunziata MA, et al. Screening for distress in cancer patients: a multicenter, nationwide study in Italy. Cancer 2013;119:17141721.

  • 6.

    Iskandarsyah A, de Klerk C, Suardi DR, et al. The Distress Thermometer and its validity: a first psychometric study in Indonesian women with breast cancer. PLoS One 2013;8:e56353.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Lim HA, Mahendran R, Chua J, et al. The Distress Thermometer as an ultra-short screening tool: a first validation study for mixed-cancer outpatients in Singapore. Compr Psychiatry 2014;55:10551062.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Martínez P, Galdón MJ, Andreu Y, et al. The Distress Thermometer in Spanish cancer patients: convergent validity and diagnostic accuracy. Support Care Cancer 2013;21:30953102.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Thalén-Lindström A, Larsson G, Hellbom M, et al. Validation of the Distress Thermometer in a Swedish population of oncology patients; accuracy of changes during six months. Eur J Oncol Nurs 2013;17:625631.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Wang Y, Zou L, Jiang M, et al. Measurement of distress in Chinese inpatients with lymphoma. Psychooncology 2013;22:15811586.

  • 11.

    Zwahlen D, Hagenbuch N, Carley MI, et al. Screening cancer patients’ families with the distress thermometer (DT): a validation study. Psychooncology 2008;17:959966.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Lotfi-Jam K, Gough K, Schofield P, et al. Profile and predictors of global distress: can the DT guide nursing practice in prostate cancer? Palliat Support Care 2014;12:514.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Olesen ML, Hansen MK, Hansson H, et al. The distress thermometer in survivors of gynaecological cancer: accuracy in screening and association with the need for person-centred support. Support Care Cancer 2018;26:11431150.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Linehan K, Fennell KM, Hughes DL, et al. Use of the Distress Thermometer in a cancer helpline context: can it detect changes in distress, is it acceptable to nurses and callers, and do high scores lead to internal referrals? Eur J Oncol Nurs 2017;26:4955.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Graves KD, Arnold SM, Love CL, et al. Distress screening in a multidisciplinary lung cancer clinic: prevalence and predictors of clinically significant distress. Lung Cancer 2007;55:215224.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Goebel S, Knuth C, Damm M, et al. Towards the targeted assessment of relevant problems: optimization of the Distress Thermometer for adult neuro-oncological patients. Psychooncology 2020;29:20572066.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Donovan KA, Handzo G, Corbett C, et al. NCCN Distress Thermometer problem list update. J Natl Compr Canc Netw 2022;20:9698.

  • 18.

    Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin 2018;68:153165.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Gordon LG, Merollini KMD, Lowe A, et al. A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay. Patient 2017;10:295309.

  • 20.

    Altice CK, Banegas MP, Tucker-Seeley RD, et al. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst 2016;109:djw205.

  • 21.

    Benedict C, Fisher S, Schapira L, et al. Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors. Psychooncology 2022;31:920.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Yabroff KR, Dowling EC, Guy GP Jr, et al. Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 2016;34:259267.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Zheng Z, Jemal A, Han X, et al. Medical financial hardship among cancer survivors in the United States. Cancer 2019;125:17371747.

  • 24.

    Coughlin SS, Ayyala DN, Tingen MS, et al. Financial distress among breast cancer survivors. Curr Cancer Rep 2020;2:4853.

  • 25.

    Grassi L, Nanni MG. Demoralization syndrome: new insights in psychosocial cancer care. Cancer 2016;122:21302133.

  • 26.

    Robinson S, Kissane DW, Brooker J, et al. A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research. J Pain Symptom Manage 2015;49:595610.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Weinstein LC, Stefancic A, Cunningham AT, et al. Cancer screening, prevention, and treatment in people with mental illness. CA Cancer J Clin 2016;66:134151.

  • 28.

    Iglay K, Santorelli ML, Hirshfield KM, et al. Impact of preexisting mental illness on all-cause and breast cancer-specific mortality in elderly patients with breast cancer. J Clin Oncol 2017;35:40124018.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Hemmington A, Huang D, Coomarasamy C, et al. When mental illness and cancer collide: an investigation of the predictors of outcomes for cancer patients with a history of mental health problems. Psychooncology 2020;29:525531.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Wootten JC, Richard L, Blanchette PS, et al. Cancer incidence and stage at diagnosis among people with recent-onset psychotic disorders: a retrospective cohort study using health administrative data from Ontario, Canada. Psychooncology 2022;31:15101518.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2022.

  • 32.

    Holland JC, Golant M, Greenberg DB, et al, eds. Psycho-Oncology: A Quick Reference on the Psychosocial Dimensions of Cancer Symptom Management. 2nd ed. Oxford University Press; 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Breitbart WS, Butow PN, Jacobsen PB, et al, eds. Psycho-Oncology. 4th ed. Oxford University Press; 2021.

  • 34.

    Holland JC, Weiss Wiesel T, Nelson CJ, et al, eds. Geriatric Psycho-Oncology: A Quick Reference on the Psychosocial Dimensions of Cancer Symptom Management. Oxford University Press; 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Wiener LS, Pao M, Kazak AE, et al, eds. Pediatric Psycho-Oncology: A Quick Reference on the Psychosocial Dimensions of Cancer Symptom Management. 2nd ed. Oxford University Press; 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Ford JS, Chou JF, Sklar CA, et al. Psychosocial outcomes in adult survivors of retinoblastoma. J Clin Oncol 2015;33:36083614.

  • 37.

    Chan CM, Ng CG, Taib NA, et al. Course and predictors of post-traumatic stress disorder in a cohort of psychologically distressed patients with cancer: a 4-year follow-up study. Cancer 2018;124:406416.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Stuber ML, Meeske KA, Krull KR, et al. Prevalence and predictors of posttraumatic stress disorder in adult survivors of childhood cancer. Pediatrics 2010;125:e11241134.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Kangas M. DSM-5 trauma and stress-related disorders: implications for screening for cancer-related stress. Front Psychiatry 2013;4:122.

  • 40.

    Cordova MJ, Riba MB, Spiegel D. Post-traumatic stress disorder and cancer. Lancet Psychiatry 2017;4:330338.

  • 41.

    Swartzman S, Booth JN, Munro A, et al. Posttraumatic stress disorder after cancer diagnosis in adults: a meta-analysis. Depress Anxiety 2017;34:327339.

  • 42.

    Abbey G, Thompson SB, Hickish T, et al. A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder. Psychooncology 2015;24:371381.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Fortin J, Leblanc M, Elgbeili G, et al. The mental health impacts of receiving a breast cancer diagnosis: a meta-analysis. Br J Cancer 2021;125:15821592.

  • 44.

    Smith SK, Zimmerman S, Williams CS, et al. Post-traumatic stress symptoms in long-term non-Hodgkin’s lymphoma survivors: does time heal? J Clin Oncol 2011;29:45264533.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Shelby RA, Golden-Kreutz DM, Andersen BL. PTSD diagnoses, subsyndromal symptoms, and comorbidities contribute to impairments for breast cancer survivors. J Trauma Stress 2008;21:165172.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Kangas M, Henry JL, Bryant RA. Predictors of posttraumatic stress disorder following cancer. Health Psychol 2005;24:579585.

  • 47.

    Green BL, Krupnick JL, Rowland JH, et al. Trauma history as a predictor of psychologic symptoms in women with breast cancer. J Clin Oncol 2000;18:10841093.

  • 48.

    Wachen JS, Patidar SM, Mulligan EA, et al. Cancer-related PTSD symptoms in a veteran sample: association with age, combat PTSD, and quality of life. Psychooncology 2014;23:921927.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Butler LD, Koopman C, Classen C, et al. Traumatic stress, life events, and emotional support in women with metastatic breast cancer: cancer-related traumatic stress symptoms associated with past and current stressors. Health Psychol 1999;18:555560.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Koopman C, Butler LD, Classen C, et al. Traumatic stress symptoms among women with recently diagnosed primary breast cancer. J Trauma Stress 2002;15:277287.

  • 51.

    Jacobsen PB, Sadler IJ, Booth-Jones M, et al. Predictors of posttraumatic stress disorder symptomatology following bone marrow transplantation for cancer. J Consult Clin Psychol 2002;70:235240.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Kangas M, Henry JL, Bryant RA. The course of psychological disorders in the 1st year after cancer diagnosis. J Consult Clin Psychol 2005;73:763768.

  • 53.

    Han WT, Collie K, Koopman C, et al. Breast cancer and problems with medical interactions: relationships with traumatic stress, emotional self-efficacy, and social support. Psychooncology 2005;14:318330.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Arnaboldi P, Riva S, Crico C, et al. A systematic literature review exploring the prevalence of post-traumatic stress disorder and the role played by stress and traumatic stress in breast cancer diagnosis and trajectory. Breast Cancer (Dove Med Press) 2017;9:473485.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Koutrouli N, Anagnostopoulos F, Potamianos G. Posttraumatic stress disorder and posttraumatic growth in breast cancer patients: a systematic review. Women Health 2012;52:503516.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Mehnert A, Lehmann C, Graefen M, et al. Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. Eur J Cancer Care (Engl) 2010;19:736745.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Shand LK, Cowlishaw S, Brooker JE, et al. Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis. Psychooncology 2015;24:624634.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Andrykowski MA, Steffens RF, Bush HM, et al. Lung cancer diagnosis and treatment as a traumatic stressor in DSM-IV and DSM-5: prevalence and relationship to mental health outcomes. J Trauma Stress 2015;28:206213.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Goebel S, Strenge H, Mehdorn HM. Acute stress in patients with brain cancer during primary care. Support Care Cancer 2012;20:14251434.

  • 60.

    Kangas M, Henry JL, Bryant RA. Correlates of acute stress disorder in cancer patients. J Trauma Stress 2007;20:325334.

  • 61.

    Rodin G, Deckert A, Tong E, et al. Traumatic stress in patients with acute leukemia: a prospective cohort study. Psychooncology 2018;27:515523.

  • 62.

    Kangas M, Henry JL, Bryant RA. The relationship between acute stress disorder and posttraumatic stress disorder following cancer. J Consult Clin Psychol 2005;73:360364.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63.

    Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 2011;12:160174.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64.

    Mehnert A, Brähler E, Faller H, et al. Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol 2014;32:35403546.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65.

    Van Beek FE, Wijnhoven LMA, Custers JAE, et al. Adjustment disorder in cancer patients after treatment: prevalence and acceptance of psychological treatment. Support Care Cancer 2022;30:17971806.

    • PubMed
    • Search Google Scholar
    • Export Citation
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