Distress screening in patients with high-grade glioma: diagnostic accuracy in relation to a structured clinical interview in a multicenter cluster-randomized controlled trial

Abstract

Purpose: Structured clinical interviews, such as the Structured Clinical Interview for DSM (SCID), are considered the gold standard for diagnosing mental disorders but are challenging in routine clinical use due to their length. Therefore, screening instruments to identify the need for further assessment are required. The National Comprehensive Cancer Network Distress Thermometer (DT) screens for psychological distress, while the Emotional Functioning (EF) scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) assesses emotional functioning. Both are frequently used in clinical routine. Additionally, three brief screening questions (TSQ), specifically developed for patients with glioma and integrated into doctor-patient consultations, may also be used for screening. This study aimed to evaluate the ability of the three tools to identify patients with psychiatric comorbidities as diagnosed by the SCID.

Methods: Using data from glioma patients treated at 13 German hospitals participating in a cluster-randomized trial, discriminative abilities were assessed using receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUCs). Confidence intervals (CIs) were estimated, and hypothesis tests were conducted using bootstrapping.

Results: Of the 691 patients interviewed, 31% presented with at least one mental disorder. The EF scale demonstrated the best discriminative ability (AUC 0.70, 95% CI: 0.66-0.74), followed by the DT (AUC 0.69, 95% CI: 0.62-0.76), and the TSQ total score (AUC 0.61, 95% CI: 0.55-0.66).

Conclusion: While all three tools performed better than random chance, none demonstrated convincing discriminative ability in identifying psychiatric comorbidities. In practice, screening tools can identify a substantial proportion of patients with mental disorders, however at the cost of a considerable number of false negatives.

Keywords: Emotional distress; High-grade glioma; Mental disorder; Psychological burden; Screening tool; Structured clinical interview (SCID).

Fig. 1

Proportions of patients with psychiatric comorbidity based on their response to each of the three screening questions (TSQ) (a) Proportions of patients with psychiatric comorbidity according to their TSQ score (b) Proportions of patients with psychiatric comorbidity according to their emotional functioning levels (note that, for the sake of clarity, EF scores with fewer than five observations were omitted) (c) Proportions of patients with psychiatric comorbidity according to their distress levels (d)

Fig. 2

Comparison of receiver operating characteristic (ROC) curves and areas and the curves (AUCs) for all considered screening tools. The three yellow dots represent the sensitivity–specificity pairs obtained from questions 1–3. The combined dark and light green areas depict the AUC of the TSQ (three screening questions) score. The light green area alone indicates the region at which the TSQ score surpasses the DT (distress thermometer). The combined purple and blue areas show the regions at which the DT outperforms the TSQ score. The blue area alone represents the region at which the DT outperforms the EF (emotional functioning) scale, while the red area denotes the region at which the EF scale surpasses the DT