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Clover K, Lambert SD, Oldmeadow C, Britton B, Mitchell AJ, Carter G, King MT. Convergent and criterion validity of PROMIS anxiety measures relative to six legacy measures and a structured diagnostic interview for anxiety in cancer patients. J Patient Rep Outcomes 2022; 6:80. [PMID: 35857151 PMCID: PMC9300804 DOI: 10.1186/s41687-022-00477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Detecting anxiety in oncology patients is important, requiring valid yet brief measures. One increasingly popular approach is the Patient Reported Outcomes Measurement Information System (PROMIS); however, its validity is not well established in oncology. We assessed the convergent and criterion validity of PROMIS anxiety measures in an oncology sample.
Methods 132 oncology/haematology outpatients completed the PROMIS Anxiety Computer Adaptive Test (PROMIS-A-CAT) and the 7 item (original) PROMIS Anxiety Short Form (PROMIS-A-SF) along with six well-established measures: Hospital Anxiety and Depression Scale-Anxiety (HADS-A); Generalised Anxiety Disorder-7 (GAD-7); Depression, Anxiety and Stress Scale-Anxiety (DASS-A) and Stress (DASS-S); Distress Thermometer (DT) and PSYCH-6. Correlations, area under the curve (AUC) and diagnostic accuracy statistics were calculated with Structured Clinical Interview as the reference standard.
Results Both PROMIS measures correlated with all legacy measures at p < .001 (Rho = .56–.83). AUCs (> .80) were good for both PROMIS measures and comparable to or better than all legacy measures. At the recommended mild cut-point (55), PROMIS-A-SF had sensitivity (.67) comparable to or better than all the legacy measures, whereas PROMIS-A-CAT sensitivity (.59) was lower than GAD-7 (.67) and HADS-A (.62), but comparable to PSYCH-6 and higher than DASS-A, DASS-S and DT. Sensitivity for both was .79. A reduced cut-point of 51 on both PROMIS measures improved sensitivity (.83–.84) although specificity was only adequate (.61–.62). Conclusions The convergent and criterion validity of the PROMIS anxiety measures in cancer populations was confirmed as equivalent, but not superior to, established measures (GAD-7 and HADS-A). The PROMIS-A-CAT did not demonstrate clear advantages over PROMIS-A-SF.
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Clover K, Lambert SD, Oldmeadow C, Britton B, King MT, Mitchell AJ, Carter G. PROMIS depression measures perform similarly to legacy measures relative to a structured diagnostic interview for depression in cancer patients. Qual Life Res 2018; 27:1357-1367. [DOI: 10.1007/s11136-018-1803-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 12/18/2022]
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Clover K, Rogers K, Britton B, Oldmeadow C, Attia J, Carter G. Reduced prevalence of pain and distress during 4 years of screening with QUICATOUCH in Australian oncology patients. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/21/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
Affiliation(s)
- K.A. Clover
- Psycho-Oncology Service; Calvary Mater Newcastle; Hunter Regional Mail Centre NSW Australia
- Centre for Brain and Mental Health Research (CBMHR); University of Newcastle; Callaghan NSW Australia
| | - K.M. Rogers
- Psycho-Oncology Service; Calvary Mater Newcastle; Hunter Regional Mail Centre NSW Australia
| | - B. Britton
- Psycho-Oncology Service; Calvary Mater Newcastle; Hunter Regional Mail Centre NSW Australia
| | - C. Oldmeadow
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - J. Attia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
- School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
- Department of Medicine; John Hunter Hospital; Newcastle NSW Australia
| | - G.L. Carter
- Centre for Brain and Mental Health Research (CBMHR); University of Newcastle; Callaghan NSW Australia
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Clover KA, Oldmeadow C, Nelson L, Rogers K, Mitchell AJ, Carter G. Which items on the distress thermometer problem list are the most distressing? Support Care Cancer 2016; 24:4549-57. [PMID: 27260016 DOI: 10.1007/s00520-016-3294-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The importance of distress identification and management in oncology has been established. We examined the relationship between distress and unmet bio-psychosocial needs, applying advanced statistical techniques, to identify which needs have the closest relationship to distress. METHODS Oncology outpatients (n = 1066) undergoing QUICATOUCH screening in an Australian cancer centre completed the distress thermometer (DT) and problem list (PL). Principal component analysis (PCA), logistic regression and classification and regression tree (CART) analyses tested the relationship between DT score (at a cut-off point of 4) and PL items. RESULTS Sixteen items were reported by <5 % of participants. PCA analysis identified four major components. Logistic regression analysis indicated three of these component scores, and four individual items (20 items in total) demonstrated a significant independent relationship with distress. The best CART model contained only two PL items: 'worry' and 'depression'. CONCLUSIONS The DT and PL function as intended, quantifying negative emotional experience (distress) and identifying bio-psychosocial sources of distress. We offer two suggestions to minimise PL response time whilst targeting PL items most related to distress, thereby increasing clinical utility. To identify patients who might require specialised psychological services, we suggest the DT followed by a short, case-finding instrument for patients over threshold on the DT. To identify other important sources of distress, we suggest using a modified PL of 14 key items, with the 15th item 'any other problem' as a simple safety net question. Shorter times for patient completion and clinician response to endorsed PL items will maximise acceptance and clinical utility.
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Affiliation(s)
- Kerrie Ann Clover
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia. .,Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia.
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia
| | - Louise Nelson
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia
| | - Kerry Rogers
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia
| | - Alex J Mitchell
- Department of Psycho-oncology, University of Leicester and Leicestershire Partnership Trust, Leicester, UK
| | - Gregory Carter
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia.,Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia
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Clover KA, Mitchell AJ, Britton B, Carter G. Why do oncology outpatients who report emotional distress decline help? Psychooncology 2014; 24:812-8. [DOI: 10.1002/pon.3729] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/14/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Kerrie Ann Clover
- Psycho-Oncology; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Newcastle New South Wales Australia
- School of Psychology; University of Newcastle; Newcastle New South Wales Australia
| | - Alex J. Mitchell
- Department of Psycho-oncology; University of Leicester and Leicestershire Partnership Trust; Leicestershire UK
| | - Ben Britton
- Psycho-Oncology; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Newcastle New South Wales Australia
| | - Gregory Carter
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Newcastle New South Wales Australia
- Consultation-Liaison Psychiatry; Calvary Mater Newcastle; Newcastle New South Wales Australia
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Abstract
CONTEXT Unexplained fatigue states are prevalent, with uncertain diagnostic boundaries. OBJECTIVE Patients with fatigue-related illnesses were investigated by questionnaire and a novel semistructured interview to identify discriminatory features. METHODS Cross-sectional samples of women from specialist practices with chronic fatigue syndrome (n = 20), postcancer fatigue (PCF; n = 20), or major depression (n = 16) were recruited. Additionally, two longitudinal samples were studied: women with fatigue associated with acute infection who subsequently developed postinfective fatigue syndrome (n = 20) or recovered uneventfully (n = 21), and women undergoing adjuvant therapy for breast cancer experiencing treatment-related fatigue who subsequently developed PCF (n = 16) or recovered uneventfully (n = 16). Patients completed self-report questionnaires, and trained interviewers applied the Semi-structured Clinical Interview for Neurasthenia. The receiver operating characteristics curves of the interview were measured against clinician-designated diagnoses. Cluster analyses were performed to empirically partition participants by symptom characteristics. RESULTS The interview had good internal consistency (Cronbach alpha "fatigue" = .83), and diagnostic sensitivity and specificity for chronic fatigue syndrome (100% and 83%) and major depression (100% and 72%), with reasonable parameters for PCF (72% and 58%). Empirical clustering by "fatigue" or "neurocognitive difficulties" items allocated most patients to one group, whereas "mood disturbance" items correctly classified patients with depression only. CONCLUSIONS The Semi-structured Clinical Interview for Neurasthenia offers reliable diagnostic use in assessing fatigue-related conditions. The symptom domains of fatigue and neurocognitive difficulties are shared across medical and psychiatric boundaries, whereas symptoms of depression such as anhedonia are distinguishing.
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Using Rasch analysis to examine the distress thermometer’s cut-off scores among a mixed group of patients with cancer. Qual Life Res 2014; 23:2257-65. [DOI: 10.1007/s11136-014-0673-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
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Maher NG, Britton B, Hoffman GR. Early screening in patients with head and neck cancer identified high levels of pain and distress. J Oral Maxillofac Surg 2013; 71:1458-64. [PMID: 23611602 DOI: 10.1016/j.joms.2013.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 02/05/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Pain and distress are recognized as the fifth and sixth vital signs in cancer care, respectively, as debilitating symptoms that are frequently under-recognized. The aim of this study was to document, using touch-screen technology, levels of pain and distress in patients with head and neck cancer before their assessment at a head and neck multidisciplinary referral clinic. MATERIALS AND METHODS A cross-sectional study over a 4-year period (2008 through 2011) was conducted for patients attending a head and neck oncology multidisciplinary team clinic in the Hunter New England referral district of Australia. Predictor variables were cancer stage and site. Cancer sites divided into 8 different regions, with distinction made for cutaneous versus noncutaneous sites. Outcome variables consisted of pain and distress levels. Pain was assessed using a Numerical Rating Scale of 0 to 10, and distress was assessed using the Distress Thermometer and PSYCH-6 scales. In the context of a screening study and for statistically comparing pain with other variables, pain was regarded as any score higher than 0. Clinically significant distress represented a Distress Thermometer score higher than 3 and a PSYCH-6 score of at least 3. Data analysis consisted of descriptive statistics, variance contrasts, and 2-tailed Pearson correlations. RESULTS Four hundred thirty-six patients were included in the study, with an equal number of cutaneous and noncutaneous cancer sites. Thirty-four percent of patients reported having pain, and 13% had clinically significant distress. Tumor stage did not significantly affect pain or distress scores. CONCLUSIONS There is a high level of pain and distress reported by patients with head and neck cancer before their assessment and management is discussed.
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Affiliation(s)
- Nigel Gordon Maher
- Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Newcastle, Australia.
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The Brisbane Longitudinal Twin Study: Pathways to Cannabis Use, Abuse, and Dependence project-current status, preliminary results, and future directions. Twin Res Hum Genet 2012. [PMID: 23187020 DOI: 10.1017/thg.2012.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We describe the data being collected from the Brisbane Longitudinal Twin Study in Australia as part of the US National Institute on Drug Abuse (NIDA)-funded project, Pathways to Cannabis Use, Abuse and Dependence. The history, recruitment, assessment, and retention of twin families in this project are described in detail, along with preliminary findings and plans for future research. The goal of this NIDA project is to make a significant contribution to the discovery of quantitative trait loci influencing cannabis use disorders. Although the focus is cannabis use, abuse, and dependence in young adults, measures of comorbid illicit drug use disorders are also being collected. In addition, a variety of internalizing and externalizing disorders are being assessed, funded by support from the Australian National Health and Medical Research Council. Because these same twins have participated in numerous twin studies since 1992, future plans will include linking different phenotypes to investigate relationships between drug use, psychiatric disorders, and psychological phenotypes within cross-sectional and longitudinal or developmental frameworks.
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Clover K, Kelly P, Rogers K, Britton B, Carter GL. Predictors of desire for help in oncology outpatients reporting pain or distress. Psychooncology 2012; 22:1611-7. [DOI: 10.1002/pon.3188] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Kerrie Clover
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
| | - Pete Kelly
- University of Wollongong; Psychology; Wollongong; New South Wales; Australia
| | - Kerry Rogers
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
| | - Ben Britton
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
| | - Gregory Leigh Carter
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
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Carey M, Noble N, Sanson-Fisher R, Mackenzie L. Identifying psychological morbidity among people with cancer using the Hospital Anxiety and Depression Scale: time to revisit first principles? Psychooncology 2011; 21:229-38. [DOI: 10.1002/pon.2057] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/31/2011] [Accepted: 08/02/2011] [Indexed: 01/06/2023]
Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
| | - Natasha Noble
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
| | - Robert Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
| | - Lisa Mackenzie
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
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Webber K, Mok K, Bennett B, Lloyd AR, Friedlander M, Juraskova I, Goldstein D. If I am in the mood, I enjoy it: an exploration of cancer-related fatigue and sexual functioning in women with breast cancer. Oncologist 2011; 16:1333-44. [PMID: 21835897 DOI: 10.1634/theoncologist.2011-0100] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We recently reported that cancer-related fatigue (CRF) after adjuvant breast cancer therapy was prevalent and disabling, but largely self-limiting within 12 months. The current paper describes sexual functioning (SF) and its relationship to CRF, mood disorder, and quality of life (QOL) over the first year after completion of adjuvant therapy. METHODS Women were recruited after surgery, but prior to commencing adjuvant treatment, for early-stage breast cancer. Self-reported validated questionnaires assessed SF, CRF, mood, menopausal symptoms, disability, and QOL at baseline, completion of therapy, and at 6 months and 12 months after treatment. RESULTS Of the 218 participants, 92 (42%) completed the SF measure (mean age, 50 years). They were significantly younger, more likely to be partnered, and less likely to be postmenopausal than nonresponders. At baseline, 40% reported problems with sexual interest and 60% reported problems with physical sexual function. SF scores declined across all domains at the end of treatment, then improved but remained below baseline at 12 months, with a significant temporal effect in the physical SF subscale and a trend for overall satisfaction. There were significant correlations between the SF and QOL domains (physical and emotional health, social functioning, and general health) as well as overall QOL. The presence of mood disorder, but not fatigue, demographic, or treatment variables, independently predicted worse overall sexual satisfaction. CONCLUSIONS Sexual dysfunction is common after breast cancer therapy and impacts QOL. Interventions should include identification and treatment of concomitant mood disorder.
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Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital, High Street, Randwick, New South Wales 2031, Australia.
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Carter G, Britton B, Clover K, Rogers K, Adams C, McElduff P. Effectiveness of QUICATOUCH: a computerised touch screen evaluation for pain and distress in ambulatory oncology patients in Newcastle, Australia. Psychooncology 2011; 21:1149-57. [PMID: 21780241 DOI: 10.1002/pon.2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 05/10/2011] [Accepted: 05/16/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the change in pain and distress over time to demonstrate the effectiveness of the QUICATOUCH program in an outpatient oncology population. METHODS Descriptive study of the first 29 months of the QUICATOUCH program (13 736 assessments for 5775 patients). A longitudinal cohort design was used to examine the patients with three or more assessments (8129 assessments for 1778 patients). Effectiveness of this complex intervention (repeated assessment, clinician report and referral to speciality psycho-oncology service) was examined using: reduction in proportion over threshold for pain and distress, predictors of mean pain and distress scores and comparison of the number of new patients treated by the psycho-oncology service during the study and in the preceding 29 months. RESULTS Pain and distress declined during the study. The risk of being over threshold at endpoint was reduced for pain (odds ratio (OR) 0.70, confidence interval (CI) 95% 0.60-0.81) and for distress (OR 0.58 CI 95% 0.49-0.68) with baseline as referent level. Three variables predicted the mean pain: clinic type, current radiotherapy treatment and distress score; and five predicted mean distress: time, gender, clinic type, age and pain score. There was an increase of 40% (533v747) in new patients treated by the psycho-oncology service. CONCLUSIONS The QUICATOUCH assessment for pain and distress was implemented into usual clinical practice with reasonable coverage of patients for modest cost. It was effective in monitoring the patients over time, contributed to a reduction in pain and distress, whilst appropriately increasing the number of new patients reaching psychological treatment as part of the clinical service.
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Affiliation(s)
- Gregory Carter
- Psycho-Oncology Service and Department Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Australia; Centre for Brain and Mental Health, University of Newcastle, NSW, Australia.
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A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Support Care Cancer 2010; 18:1241-62. [PMID: 20596731 DOI: 10.1007/s00520-010-0932-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/31/2010] [Indexed: 10/19/2022]
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