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

backgroundMetastatic 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.

objectiveThis 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.

methodsA 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.

resultsThe 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.

conclusionPsychological 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.