DISTRESS THERMOMETER SCORES AND OUTCOMES IN METASTATIC BREAST, COLORECTAL, AND LUNG CANCER: REAL-WORLD EVIDENCE FROM A LARGE US COMMUNITY ONCOLOGY SETTING
Author(s)
Zhaohui Su, PhD, Kat Aguilar, MPH, PhD(c), Saamir Pasha, MPH, Biswajit Brahma, DSc, Jennifer Frytak, PhD, Janet Espirito, PharmD, Jessica Paulus, ScD;
Ontada, Boston, MA, USA
Ontada, Boston, MA, USA
OBJECTIVES: Psychosocial distress is common among cancer patients and may affect health outcomes. This study examined distress thermometer (DT) scores, the frequency of reported problems, and the association between distress and patient outcomes in a large US community oncology setting.
METHODS: This retrospective cohort study included adults with metastatic breast (mBC), colorectal (mCRC), or non-small cell lung cancer (mNSCLC) who completed the DT questionnaire in the iKnowMed electronic health record between January 2023 and December 2025. Initial (index) DT scores were categorized as mild (1-3), moderate (4-6), and severe (7-10), while problem-list items were grouped by domain. Prognostic value for overall survival (OS) was assessed using multivariable time-dependent Cox models adjusted for demographic and clinical factors.
RESULTS: Among 4,829 patients (41% mBC, 25% mCRC, 34% mNSCLC), median (IQR) age was 67 (58-76), with 70% female, 82% White. Median index DT was 4 (IQR 2-6), classified as mild (50%), moderate (31%), and severe (19%), with emotional (56%) and physical (71%) domains being the most common concerns. Poor performance status (Eastern Cooperative Oncology Group score ≥2) was observed among 29% of patients with severe distress versus 20% overall (P<0.0001). DT thresholds ≥4 and ≥7 provided meaningful risk stratification for OS consistently across cancer types (Log-Rank test P<0.0001, 0.0003, <0.0001 for mBC, mCRC, and mNSCLC, respectively). After adjusting for covariates, significantly shorter OS was associated with severe distress in mNSCLC (hazard ratio [HR] 1.52 [95% confidence interval (CI): 1.22-1.89]), and with physical concerns in mBC (HR 1.43 [95% CI: 1.09-1.89]) and mCRC (HR 1.42 [95% CI: 1.09-1.85]). Improvement in DT scores over time was linked to better OS in mCRC (HR 0.49 [95% CI: 0.31-0.76]).
CONCLUSIONS: DT scores and problem-list domains capture patient-reported burden and predict OS beyond clinical variables. Routine DT screening offers actionable prognostic information to guide supportive care and risk stratification in oncology practice.
METHODS: This retrospective cohort study included adults with metastatic breast (mBC), colorectal (mCRC), or non-small cell lung cancer (mNSCLC) who completed the DT questionnaire in the iKnowMed electronic health record between January 2023 and December 2025. Initial (index) DT scores were categorized as mild (1-3), moderate (4-6), and severe (7-10), while problem-list items were grouped by domain. Prognostic value for overall survival (OS) was assessed using multivariable time-dependent Cox models adjusted for demographic and clinical factors.
RESULTS: Among 4,829 patients (41% mBC, 25% mCRC, 34% mNSCLC), median (IQR) age was 67 (58-76), with 70% female, 82% White. Median index DT was 4 (IQR 2-6), classified as mild (50%), moderate (31%), and severe (19%), with emotional (56%) and physical (71%) domains being the most common concerns. Poor performance status (Eastern Cooperative Oncology Group score ≥2) was observed among 29% of patients with severe distress versus 20% overall (P<0.0001). DT thresholds ≥4 and ≥7 provided meaningful risk stratification for OS consistently across cancer types (Log-Rank test P<0.0001, 0.0003, <0.0001 for mBC, mCRC, and mNSCLC, respectively). After adjusting for covariates, significantly shorter OS was associated with severe distress in mNSCLC (hazard ratio [HR] 1.52 [95% confidence interval (CI): 1.22-1.89]), and with physical concerns in mBC (HR 1.43 [95% CI: 1.09-1.89]) and mCRC (HR 1.42 [95% CI: 1.09-1.85]). Improvement in DT scores over time was linked to better OS in mCRC (HR 0.49 [95% CI: 0.31-0.76]).
CONCLUSIONS: DT scores and problem-list domains capture patient-reported burden and predict OS beyond clinical variables. Routine DT screening offers actionable prognostic information to guide supportive care and risk stratification in oncology practice.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR99
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Oncology