Talk from IPOS10

1. T276 - -A Large Scale Validation of the Emotion Thermometers as
T276 A Large Scale Validation of the Emotion Thermometers as
aaScreening Tool for MDD & Distress in an Ethnically Diverse
Screening Tool for MDD & Distress in an Ethnically Diverse
Cancer Population
Cancer Population
Alex Mitchell www.psycho-oncology.info
Paul Symonds
Lorraine Grainger
Elena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010

2. Audit / Research Protocol
Phase I – DT across LNR network (incl training)
Phase II – Enhancements to DT
Phase III - Screening plus Intervention

3. Phase I

4. Qualitative Limitations of DT
DT not always interpreted by patients
Distress not always understood by patients
There is no anchor
Patients who are angry or depressed may not say
“distressed”
But some patients may not interpret “depression”

5. Quantitative Limitations of DT
Of 401 chemotherapy attendees
59% have an emotional complication (3v4)
37% (62% of 59%) it included distress
23% it excluded distress
Validity of DT vs depression (DSMIV)
SE 80% SP 60% PPV 32% NPV 93%

6. Phase II

7. ET - Table of Cut-Points
Distress Anxiety Depression Anger Help
Thermomete thermomet Thermomete Thermomete Thermomete
r er r r r Cut-point
Insignifica
nt 39.0 25.6 50.1 55.7 54.3 0,1
Minimal 20.1 22.5 18.3 13.6 15.4 2,3
Mild 16.9 16.5 12.2 10.5 12.2 4,5
Moderate 12.0 14.5 9.8 6.6 6.6 6,7
Severe 11.9 20.8 9.5 13.6 11.2 8,9,10
p130

8. 1.00
0.90
0.80
Ten
0.70 Nine
Eight
0.60 Seven
Six
0.50
Five
Four
0.40
Three
Two
0.30
One
0.20
Zero
0.10
0.00
Distress Anxiety Depression Anger
Thermometer Thermometer Thermometer Thermometer

9. DepT
DT
23%
37%
4% 3%
3%
DT DepT
7% 1%
Non-Nil 8% 0% Nil
9%
59% 41%
4% 1%
AnxT 2% AngT
15% 2%
AnxT AngT
47% 18%

10. Phase II

11. Top 10 patient concerns
1 Anxiety 312
2 Family concerns 157
3 Independence/Role 122
4 Appearance 111
5 Pain 86
6 Sleep 76
7 Fatigue/Energy 71
8 Finances 63
9 Weight 52
10 Breathing 49

12. Concerns linked with distress
t = 7.705129 P < 0.0001 Anxiety
t = 4.859186 P < 0.0001 depression/hopeless
t = 4.448083 P < 0.0001 Family concerns/issues
t = 4.10916 P < 0.0001 Anger/Irritability
t = 2.699969 P = 0.0073 Self-Esteem
t = 2.69652 P = 0.0073 Cancer worries
t = 2.497361 P = 0.013 Coping concerns
t = 2.371534 P = 0.0183 Sleep

13. Validity of the ET

14. Vs DT DepT
HADS-A
AUC:
DT=0.82
DepT=0.84
AnxT=0.87 AnxT AngT
AngT=0.685

15. Graphical – Screening principles
#
of Cut-Off
Individuals
Low High
Non-Depressed
<<<< low Specificity
Severity of Depression
High Sensitivity >>>> Depressed
#
of
Individuals

16. Validity Against HADS-T (distress)
We analysed data collected from Leicester Cancer Centre
from 2007-2009
The researcher applied the HADS and used a HADS-T >14
to signify distress.
We collated full data on 660 patient assessments

17. HADS-T
In the parent sample of 660:
SE SP AUC CUT
DT – 71.9% 78.4% 0.814 cut point =4

18. HADS-T
In the parent sample of 660:
SE SP AUC CUT
DT – 71.9% 78.4% 0.814 cut point =4
AnxT – 75.7% 73.4% 0.821 cut point =5
DepT – 77.6% 82.2% 0.855 cut point =3
AngT – 77.5% 77.6% 0.823 cut point =2
HelpT - 69.1% 80.8% 0.809 cut point =3

19. Against MDD
The researcher applied criteria for MDD. We collated full data on
660 patient assessments
MDD was defined by DSMIV criteria (5 of 9 symptoms)
12.9% had MDD and 14.8% were from ethnic minorities (largely
British South Asian of India descent).

20. Validity vs MDD - Results
SENSITIVITY SPECIFICITY AUC
DT – 82.4% 68.6% 0.811

21. Validity vs MDD - Results
SENSITIVITY SPECIFICITY AUC
DT – 82.4% 68.6% 0.811
AnxT – 85.9% 56.2% 0.774
DepT – 80.0% 78.2% 0.853
AngT – 83.5% 66.1% 0.782
HelpT - 68.2% 79.1% 0.799

22. Whole Sample vs MDD
100.00%
Sensitivity
90.00%
Specificity
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
DT – AnxT – DepT – AngT – HelpT -

23. Validity vs MDD – 15% minorities
SENSITIVITY SPECIFICITY AUC
DT BSA - 100% 56.9% 0.827
AnxT BSA - 72% 72.1% 0.730
DepT BSA - 80.0% 69.4% 0.770
AngT BSA - 84.0% 65.3% 0.782
HelpT BSA - 92% 56.9% 0.791

24. BSA vs MDD
100%
Sensitivity
90%
Specificity
80%
70%
60%
50%
40%
30%
20%
10%
0%
DT – AnxT – DepT – AngT – HelpT -

25. Summary
Against Distress
All thermometers were “good” but DepT was best
Against Depression (all)
DepT > DT were “good”
Against Depression in BSA
DT may be best?