Screening for distress among metastatic breast cancer patients at a tertiary cancer center in Southwest Nigeria: Using the NCCN distress thermometer

Document Type

Journal Article

Publication Date

1-13-2026

Journal

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

Volume

34

Issue

2

DOI

10.1007/s00520-025-10223-3

Keywords

LMIC; Metastatic breast cancer; NCCN distress thermometer; Nigeria; Psychological distress; Psychosocial oncology; Supportive care

Abstract

BACKGROUND: Metastatic breast cancer (MBC) patients in low- and middle-income countries (LMICs) face unique psychosocial challenges due to advanced disease presentation, financial burdens, and limited access to supportive care. Psychological distress (PD), a critical determinant of treatment adherence and quality of life, remains under-recognized and under-treated in these settings. The Distress Thermometer (DT), a simple screening tool endorsed by the National Comprehensive Cancer Network (NCCN), offers potential for systematic PD assessment. OBJECTIVE: This study assessed the performance of the DT in identifying PD among MBC patients and evaluated its correlation with clinical and sociodemographic factors at a tertiary cancer center (NSIA-LUTH) in Lagos, Southwest Nigeria. METHODS: A cross-sectional study was conducted involving 313 patients diagnosed with metastatic breast cancer. Eligible participants, aged ≥ 18 years and cognitively intact, completed the DT alongside a comprehensive problem checklist. Psychological distress was defined as a DT score ≥ 4. Sociodemographic, clinical, and psychosocial data were retrieved from electronic medical records. RESULTS: The median age of participants was 53 years, with 98.7% being female. The most common metastatic sites were lungs (53.0%), spine (48.2%), and liver (13.4%). Triple-negative breast cancer was predominant (51.1%). Moderate to severe distress (DT score ≥ 4) was identified in 46% of patients. Primary concerns included insurance-related issues (73.2%), treatment-related concerns (62.3%), and transportation difficulties (59.4%). Psychological manifestations were dominated by worry (62.3%) and anhedonia (50.8%). Physical symptom burden was substantial, with sleep disturbance (57.2%), pain (56.2%), and eating difficulties (52.4%) being most prevalent. Strong family-based support systems were noted, with 75% of patients having primary caregivers. Patients experienced an average of 2.81 concurrent psychosocial challenges and 4.36 concurrent physical symptoms. CONCLUSION: Psychological distress is highly prevalent (46%) among MBC patients in this LMIC setting, driven by insurance-related concerns, transportation difficulties, and substantial symptom burden.. The DT successfully identified patients with clinically significant distress (DT ≥ 4), supporting its feasibility for routine psychosocial screening in resource-limited oncology settings.

Department

Prevention and Community Health

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