Identifying psychological distress at key stages of the cancer illness trajectory: a systematic review of validated self-report measures

Context: To enable study of psychological distress along the cancer journey, we need to be able to select and map validated measures through the cancer trajectory.

Objectives: To examine the performance of self-report measures for identifying clinically significant levels of psychological distress across the cancer patient trajectory.

Methods: Electronic searches of Medline, PsychInfo, CINAHL, EmBase, The Cochrane Library, AMED, BNI, ASSIA, and Web of Science were undertaken. Only studies of self-report measures that used validated diagnostic tools for psychiatric diagnosis as the criterion measure were included. We then further limited our focus to those papers that specified a trajectory stage.

Results: Forty-eight different self-report measures were reported in the 85 papers identified. The Hospital Anxiety and Depression Scale (HADS) was the most frequently reported measure (23 times). Several other measures were reported between two and four times, but most (37) measures were reported only once. Twenty-two of the 85 included papers reported measure performance by trajectory stage. Best performing measures based on validation data available could be identified for each trajectory stage: for pretreatment, the HADS for identifying depression; during treatment, the HADS and Mental Health Inventory-5 (MHI-5) together for identifying clinically significant distress; post-treatment, the HADS for identifying depression; and at recurrence and during the palliative phase, the Brief Edinburgh Depression Scale (BEDS) for identifying depression.

Conclusion: No single measure had evidence to support use throughout the illness trajectory in a longitudinal study, but the HADS, in combination with the MHI-5, was supported during the cancer treatment phase, and BEDS in the palliative care phase.