Communicate Your Distress

Key Points

  • When distress is high, problems can arise in one or more areas of life.
  • Distress screening is a brief assessment of distress and its extent.
  • Several distress screening tools are available.
  • If your cancer care team does not initiate a distress screening or other psychosocial assessment, you can ask for a referral to an oncology social worker, oncology nurse navigator or psychotherapist who can provide assessment and referral for psychosocial concerns as well as distress.

A cancer diagnosis often causes distress, as can cancer treatments. Typically, doctors don’t ask about distress, and patients don't say anything unless they're asked.

Your quality of life during and after cancer treatment, and even the success of your treatment, can be impaired by high distress.

Common symptoms of distress include these:2

  • Sadness, fear, and helplessness
  • Anger, feeling out of control
  • Questioning your faith, your purpose, the meaning of life
  • Pulling away from people, including those close to you
  • Concerns about illness
  • Concerns about your social role (as a mother, father, caregiver, and so on)
  • Poor sleep, appetite, or concentration
  • Depression, anxiety, panic
  • Frequent thoughts of illness and death

Distress is often eased with the health-supportive measures described on this site.

Screening Tools

NCCN distress thermometer
Distress thermometer from the National Comprehensive Cancer Network; click to open the tool for printing

Good distress screening tools:

Usually, an oncology social worker conducts the psychosocial assessment, but so may nurses, doctors, or psychologists. Distress screening is not typically done right at diagnosis and the beginning of treatment when nearly everyone’s distress is usually fairly high. Instead, a screening may occur a few weeks after treatment starts, when acute distress is expected to ease. A higher level of distress at this time is a signal that you might need a referral for help.

Distress screening is not typically done right at diagnosis and the beginning of treatment when nearly everyone’s distress is usually fairly high. Instead, a screening may occur a few weeks after treatment starts.

After your cancer diagnosis, you might ask your doctor if and when someone will be asking about your emotional, social, and financial concerns and challenges (psychosocial assessment). Ask if and when someone will be doing a distress screening with you. If your cancer treatment team is not providing these assessments, you can ask for a referral to an oncology social worker, oncology nurse navigator, or psychotherapist who can provide assessment and referral for psychosocial concerns as well as distress.

If you have not been screened for distress, and you have concerns about your level of distress, you might consider completing the NCCN Distress Screening and Problem List Tool. If you feel your distress level is too high, take a copy of the completed tool to your oncology doctor, social worker and/or treatment nurse to review and refer you to resources for help.

Cancer programs that are accredited by the American College of Surgeons Commission on Cancer (ACOS COC) are required to conduct a psychosocial assessment and routine distress screening of all their patients.

In summary, the cancer experience can be distressing. Higher levels of ongoing distress can impair your quality of life and treatment success. Let your cancer treatment team know if you are experiencing distress and ask for help.

Getting Help

If you are experiencing distress, even if it isn’t severe, getting help may be useful. Some suggestions from the Cancer.Net article titled How to Recognize Cancer Distress and Cope with It include:

  • Talk to your cancer care team.
  • Connect with other cancer survivors.
  • Get counseling.

The Related Pages section below includes resources for managing distressing cancer symptoms and stress that are located on this site .

Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on July 5, 2018.

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