The psychosocial screen for cancer (PSSCAN): further validation and normative data

Abstract

Background: We have previously reported on the development of a cancer-specific screening instrument for anxiety and depression (PSSCAN). No information on cut-off scores or their meaning for diagnosis was available when PSSCAN was first described. Needed were additional analyses to recommend empirically justified cut-off scores as well as data norms for healthy adult samples so as to lend meaning to the recommended cut-off scores.

Methods: We computed sensitivity/specificity indices based on a sample of 101 cancer patients who had provided PSSCAN data on anxiety and depression and who had completed another standardized instrument with strong psychometrics. Next, we compared mean scores for four samples with known differences in health status, a healthy community sample (n = 561), a sample of patients with a representative mix of cancer subtypes (n = 570), a more severely ill sample of in-patients with cancer (n = 78), and a community sample with a chronic illness other than cancer (n = 85).

Results: Sensitivity/specificity analyses revealed that an excellent balance of sensitivity/specificity was achievable with 92%/98% respectively for clinical anxiety and 100% and 86% respectively for clinical depression. Newly diagnosed patients with cancer were no more anxious than healthy community controls but showed elevations in depression scores. Both, patients with chronic illness other than cancer and those with longer-standing cancer diagnoses revealed greater levels of distress than newly diagnosed cancer patients or healthy adult controls.

Conclusion: These additional data on criterion validity and community versus patient norms for PSSCAN serve to enhance its utility for clinical practice.

Figure 1

a and b. Receiver Operating Curves for the Anxiety Subscale of the PSSCAN with the Anxiety Subscale of the HADS as the Criterion; Fig a: subclinical threshold; Fig b clinical threshold.

Figure 2

a and b. Receiver Operating Curves for the Depression Subscale of the PSSCAN with the Depression Subscale of the HADS as the Criterion; Fig a subclinical threshold; Fig b clinical threshold).