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Tools to Help Measure Distress

Sometimes it’s hard to talk about distress in a way that helps your cancer care team understand how much you’re having and how it’s affecting you.

Distress screening

You've probably been asked to give a pain level based on a scale of 0 to 10 during doctor and hospital visits. The pain scale works like this: You might be asked, “How is your pain right now on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine?” This is a helpful way to measure pain. A score above 5 is usually a sign of significant pain, and tells the health care team that the patient needs more help to manage it.

Some cancer care teams measure distress in the same way, using a 0 to 10 scale. A common one used by many cancer care teams is the Distress Thermometer (see example below). Just as with the pain scale, you’re asked to choose a number from 0 to 10 that reflects how much distress you feel today and how much you felt over the past week. Ten is the highest level of distress you can imagine, and 0 is no distress. Most people can use this scale to rate their distress in a way that helps the cancer care team. If your response is 4 or above, you likely have a moderate-to-high degree of distress. Your doctor and/or cancer care team should find out more and offer some help with your distress.

Not only does this tool tell your team about your emotional health, but it also gives you a chance to talk and work out problems during your visit. Surveys done in cancer clinics have shown that up to 4 in 10 patients have significant levels of distress. You are not alone in your distress.

Another part of the distress tool is the Problem List, or a list of things that may be causing your distress. For this, you read through a list of common problems and mark possible reasons for your distress. This helps your cancer care team know where you can best get the help you need. The list of physical problems helps you remember those you should tell your treatment team about.

The distress thermometer

You are asked to circle the number (0-10) that best describes how much distress you’ve had during the past week, including the present day.

Illustration of a distress thermometer to measure the amount of stress someone has had during the past week.  Goes from 0 (no distress) to 10 (extreme distress)

The problem list

You are asked to check NO or YES for each problem (physical, emotional, activity, family, social, or spiritual) that has been a cause of your distress in the past week, including the present day. 

You can see and learn more about the Distress Thermometer and Problem List on the National Comprehensive Cancer Network website

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

Dahlin C. Anxiety. In Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse. 3rd ed. Pittsburgh, PA: Oncology Nursing Society; 2014; 1383-1390.

Hammelef KJ, Tavernier SS. Distress. In Brown CG (ed.). A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society. 2015; 265-281..

National Comprehensive Cancer Network (NCCN). Patient and Family Resources: Managing Stress and Distress. Accessed at on January 31, 2020.


Last Revised: February 1, 2020

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