Assessing Distress

Key points

  • Life-limiting illnesses such as cancer or end-stage organ failure may, in some people, cause significant distress and suffering
    • Distress levels tend to vary at different timepoints in an illness - often peaking at diagnosis, and at other turning points in the course of the disease
    • High levels of distress affect a person’s ability to cope with their illness, its symptoms and its treatment, and with decision making about treatment and care
    • Distress affects not just the patient but also, often, their family.
  • Distress may be experienced as psychological, emotional, spiritual, social or physical, or any combination of these.
  • Distress may range from painful emotion states that come and go as part of the adjustment process, to significant mental health problems requiring specialised help. These include:
    • Anxiety disorders, panic disorders, post-traumatic stress disorder (PTSD)
    • Depression
    • Adjustment disorder.
  • Risk factors for higher levels of distress include:
    • Poor performance state, difficulty managing activities of daily living (ADLs)
    • Sense of being a burden
    • High symptom burden from disease or treatment
    • Family conflict or difficulties
    • History of depression or other mental health issues
    • Younger patients, female patients
    • Lower levels of education.
  • Routine screening for distress is important because these problems may not be raised by patients spontaneously, and timely supportive care can greatly improve the person’s quality of life. Appropriate referrals could include:
    • Social worker
    • Pastoral care worker or person from their faith community
    • Mental health professional
    • Palliative care specialist
    • Check local HealthPathways for referral processes.


Clinical practice guideline - The psychosocial care of adults with cancer

Clinical practice guidelines for the psychosocial care of adults with cancer (176kb pdf)

This summary provides evidence based Australian strategies and advice for clinicians working with patients with cancer, including helpful prompts for starting conversations about psychosocial concerns.

From: Cancer Australia. Clinical practice guidelines for the psychosocial care of adults with cancer: a summary guide for health professionals. 2004.

PDQ Adjustment to Cancer - Anxiety and distress - Information for professionals

Evidence based guidance on assessment and management of a range of mental health conditions associated with cancer and it's treatment is available from the National Cancer Institute (NCI).

From: National Cancer Institute (US)

Free full text article - Anxiety, depression and cancer

Anxiety, depression and cancer

This supplement provides Australian evidence about the prevalence and importance of psychosocial distress in cancer populations, and the effectiveness of interventions to screen and support patients.

From: Med J Aust. 2010 Sep 6;193(5 Supp).

Distress Thermometer - Assesses psychosocial distress

The Distress Thermometer is a pen and paper tool for patients to report how distressed they are about their psychosocial and physical problems. 

Representative Image of the NCCN Distress Thermometer
Download the NCCN Distress Thermometer (296kb pdf)

From: National Comprehensive Cancer Network (NCCN)

DQ Adjustment to Cancer - Anxiety and distress - Information for patients

Information for patients about mental health conditions associated with cancer.

From: National Cancer Institute (US)

Last updated 11 February 2020