The effectiveness of a nurse-led intervention with the distress thermometer for patients treated with curative intent for breast cancer: design of a randomized controlled trial.

Background Distress in patients with cancer influences their quality of life. Worldwide, screening on distress with the Distress Thermometer (DT) in patients with cancer is recommended. However, the effects of the use of the DT on the psychosocial wellbeing of the patient are unknown. A study to assess the psychosocial consequences of the systematic use of the DT and its discussion by a nurse as compared to the usual care provided to outpatients who are treated for primary breast cancer is needed.Methods/design The effectiveness of a nurse-led intervention with the DT will be tested in a non-blinded randomized controlled trial. Patients treated with curative intent for breast cancer will be recruited from the Radboud University Medical Center. The intervention consists of the DT together with discussion of the results with the patient by a trained oncology nurse added to the usual care. Patients will be randomly allocated (1:1) to either receive usual care or the usual care plus the intervention. Primary outcome measure is global quality of life measured with the EORTC QLQ-C30. The functional and symptom scales of the EORTC QLQ-C30 and BR23, Hospital Anxiety and Depression Scale, Impact of Event Scale, Illness Cognition Questionnaire and DT (baseline and final measurement only) will be used to measure secondary outcomes. Questionnaires are obtained in both arms at baseline, after completion of each type of cancer treatment modality and during follow up, with a three and six months' interval during the first and second year respectively.Discussion This study will be the first randomized controlled longitudinal study about the effectiveness of the DT as nurse led-intervention. In case of proven effectiveness, future implementation and standardization of use of the DT as part of routine care will be recommended.Trial registration This study is registered at clinicaltrial.gov march 17, 2010 ( NCT01091584 )

A Specific Distress Cutoff Score Shortly After Breast Cancer Diagnosis.

Background High levels of distress are expected shortly after the diagnosis breast cancer. The Distress Thermometer (DT) is commonly used to screen for distress, using a cutoff score of 4 or 5; however, this score might not be appropriate for detecting distress in women with recently diagnosed breast cancer.Objectives The aims of this study were to establish the optimal DT cutoff score for detecting high distress shortly after breast cancer diagnosis and to correlate this score with the reported problems.Methods We selected for this study Dutch women who completed the DT and the Hospital Anxiety and Depression Scale within 1 month after breast cancer diagnosis. Receiver operating characteristic analysis of DT scores was performed, with the Hospital Anxiety and Depression Scale being used as the criterion standard for the level of distress. The sensitivity, specificity, positive predictive value, and negative predictive value of each DT score were calculated.Results In total, 181 women participated in the study. The optimal DT cutoff score for detecting distress was 7 with a sensitivity of 0.73, specificity of 0.84, positive predictive value of 69%, and negative predictive value of 87%. Emotional problems were the most frequently reported concerns.Conclusion We consider a cutoff score of 7, shortly after breast cancer is diagnosed, optimal to identify those women with high distress and therefore at risk of chronic distress.Implications for practice The findings are clinically important because they can enable healthcare professionals to direct their time and resources to those most in need of their assistance

Pediatr Nephrol

Survival in the pediatric end-stage renal disease (ESRD) population has improved substantially over recent decades. Nonetheless, mortality remains at least 30 times higher than that of healthy peers. Patient survival is multifactorial and dependent on various patient and treatment characteristics and degree of economic welfare of the country in which a patient is treated. In this educational review, we aim to delineate current evidence regarding mortality risk in the pediatric ESRD population and provide pediatric nephrologists with up-to-date information required to counsel affected families