Abstract

Background

Childhood cancer survivors should be routinely screened for psychological distress. However, existing screening tools promoted by cancer care institutions, such as the Distress Thermometer (DT) generate high rates of errors. The aim of this study is to help refining strategies of screening psychological distress in this population by exploring two-step methods combining the DT on step #1 with one question on step #2.

Procedure

Data from 255 survivors of childhood acute lymphoblastic leukemia aged 13–40 years were analyzed (38% 13–18 years, 62% 19+ years, 53% females). We used the DT on step #1 and the individual emotion items from the Pediatric Quality of Life Questionnaire (PedsQL) on step #2, to detect distress, depression and anxiety as measured by standard instruments. We compared sensitivity, specificity, negative and positive predictive values, Youden index, and clinical utility indices, in newly developed two-step strategies.

Results

The best two-step strategies to screen anxious-depressive distress were DT ≥ 2 on step #1, with the item of Sadness on step #2, and DT ≥ 2 combined with the item of Concerns. Two-step strategies outperformed the DT alone on the correct identification of distressed survivors. However, two-step strategies did not outperform the DT used alone on the correct detection of no distressed survivors. Results were similar when predicting depression or anxiety alone.

Conclusion

Completing the DT with one single question on emotions from the PedsQL may minimize the number of participants falsely identified as distressed, which could be particularly pertinent in resource-limited clinics.

中文翻译：

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筛查儿科癌症幸存者的痛苦：一步和两步策略的系统比较，以尽量减少检测错误

摘要

背景

儿童癌症幸存者应定期接受心理困扰筛查。然而，癌症护理机构推广的现有筛查工具，例如遇险温度计 (DT)，会产生很高的错误率。本研究的目的是通过探索将第 1 步中的 DT 与第 2 步中的一个问题相结合的两步方法，帮助改进筛查该人群心理困扰的策略。

程序

分析了 255 名 13-40 岁儿童急性淋巴细胞白血病幸存者的数据（38% 13-18 岁，62% 19 岁以上，53% 女性）。我们在第 1 步中使用了 DT，在第 2 步中使用儿科生活质量问卷 (PedsQL) 中的个人情绪项目来检测通过标准仪器测量的痛苦、抑郁和焦虑。我们在新开发的两步策略中比较了敏感性、特异性、阴性和阳性预测值、约登指数和临床效用指数。

结果

筛查焦虑-抑郁困扰的最佳两步策略是第 1 步的 DT ≥ 2，第 2 步的“悲伤”项目，以及 DT ≥ 2 的“关注”项目。在正确识别痛苦的幸存者方面，两步策略优于单独的 DT。然而，两步策略在正确检测到没有痛苦的幸存者方面并没有优于单独使用的 DT。单独预测抑郁或焦虑时，结果相似。

结论

用 PedsQL 中关于情绪的一个问题来完成 DT 可以最大限度地减少被错误地识别为痛苦的参与者的数量，这在资源有限的诊所中可能尤其相关。