Supporting cancer patients in managing distress: new insights in the use of the Distress Thermometer & Problem List and effects of web-based support programs

Appropriate screening and adequate management of patients’ distress and underlying problems is of great importance in adjusting well to the cancer experience. The Dutch Distress Thermometer and Problem List (DT/PL) is often used for screening in clinical practice but knowledge about factors associated with high distress, underlying problems and with having a referral wish is limited. Also, web-based programs seem promising in supporting cancer patients but relatively little is known about their effects. In the current thesis, several factors were identified that can help recognize patients who are more at risk to experience high distress and who are more likely to express a referral wish to supportive care. Factors predicting higher distress were not identical to the variables associated with a referral wish and underlines the importance of discussing DT/PL responses with all patients to determine who would desire/need additional care. Even years after diagnosis, problems can persist and thus, screening and management of distress remains important. The current thesis also showed that web-based support programs are feasible and can be effective in alleviating patients’ problems. However, studies within this field require improvement regarding the methodological quality. In the coming years, it is expected that the evidence for the efficacy of web-based interventions will further accumulate. Thus, both screening and web-based programs can be of valuable addition to traditional practices in cancer care. Hopefully, these approaches will soon be fully integrated in routine cancer care worldwide