NCCN Thermometer Detects High Psychological Distress in Breast Cancer

Investigators at the NSIA-LUTH Cancer Centre in Lagos, Southwest Nigeria, utilized the NCCN Distress Thermometer (DT) to identify high prevalence of psychological distress among patients with metastatic breast cancer in low- and middle-income countries, according to findings from a cross-sectional study published in Supportive Care in Cancer.

The study sought to evaluate the performance of the DT tool in a resource-limited tertiary care setting and assess how sociodemographic and clinical factors correlated with patient-reported distress. Researchers found that 46% of patients with metastatic breast cancer experienced moderate-to-severe psychological distress, highlighting a critical need for routine psychosocial screening to improve treatment adherence and quality of life in this population.

Main Study Data

Data from the study indicated that 46% of the participants scored 4 or higher on the NCCN DT, which is the established threshold for clinically significant distress. The mean DT score among the total cohort was 3.42. Patients experienced a significant burden of concurrent challenges, reporting an average of 2.81 psychosocial issues and 4.36 physical symptoms.

The primary drivers of distress were identified through a comprehensive problem checklist. Insurance-related issues were the most frequent concern, reported by 73.2% of patients. Other significant practical and emotional concerns included treatment-related worries (62.3%) and transportation difficulties (59.4%). Additionally, 50.8% of patients reported experiencing anhedonia.

Physical symptoms also contributed heavily to the reported distress levels. The most prevalent physical symptoms reported by patients with metastatic breast cancer were sleep disturbances (57.2%), pain (56.2%), and eating difficulties (52.4%). Notably, the investigators observed that despite the high levels of distress, 75% of patients had primary caregivers, indicating a strong family-based support system within the study population.

When analyzing clinical correlations, triple-negative breast cancer (TNBC) was the predominant subtype, seen in 51.1% of patients. The most common sites of metastasis were the lungs (53.0%), followed by the spine (48.2%) and the liver (13.4%). The study results confirmed that the NCCN DT was a feasible and effective instrument for identifying distress in this setting, as it correlated with a high volume of practical, emotional, and physical problems reported by the patients.

“This comprehensive analysis of distress patterns among patients [with metastatic breast cancer] in Southwest Nigeria provides crucial insights into the multifaceted nature of psychological burden in this population. Herein, we highlight the high prevalence of [psychological distress] among patients [with metastatic breast cancer] and affirm the utility of the DT as an effective screening tool in resource-constrained oncology settings,” Adewumi Alabi, MD, from the Department of Radiation Biology, Radiotherapy & Radiodiagnosis at the College of Medicine of University of Lagos, wrote with colleagues in the article.

Trial Details

This cross-sectional study was conducted between September 2020 and February 2022 at the NSIA-LUTH Cancer Centre, a tertiary oncology facility located at the Lagos University Teaching Hospital in Nigeria. The study enrolled 313 patients who were diagnosed with metastatic breast cancer. To be eligible for participation, patients had to be 18 years of age or older and cognitively able to provide informed consent and complete the assessment tools.

Patients completed the NCCN DT, a visual analog scale ranging from 0 (no distress) to 10 (extreme distress), alongside the accompanying NCCN Problem Checklist. The checklist allowed patients to categorize their concerns into 5 domains: practical, family, emotional, spiritual/religious, and physical. Psychological distress was defined as a DT score of 4 or higher. Investigators retrieved additional sociodemographic, clinical, and psychosocial data from electronic medical records to provide a comprehensive analysis of the factors influencing DT scores. The study population had a median age of 53 years, and 98.7% of the patients were female.

Reference

Alabi A, Lawal A, Fatiregun O, et al. Screening for distress among metastatic breast cancer patients at a tertiary cancer center in Southwest Nigeria: using the NCCN distress thermometer. Support Care Cancer. 2026;34(2):90. doi:10.1007/s00520-025-10223-3