Cancer and treatment distress psychometric evaluation over time: A BMT CTN 0902 secondary analysis: CTXD Psychometric Evaluation Over Time

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Routine monitoring of cancer-related distress is recognized as essential to quality care and mandated by a major accrediting organization. However, to the authors' knowledge, few cancer-specific measures have been developed to date to assess the multiple cancer-related factors contributing to this distress. In the current study, the authors examined the psychometric properties of the Cancer and Treatment Distress (CTXD) measure over time in hematopoietic cell transplantation (HCT) recipients.


As a secondary analysis of a multicenter randomized controlled clinical trial, adult patients undergoing autologous or allogeneic HCT completed patient-reported outcomes including the CTXD and the Medical Outcomes Study Short Form-36 (SF-36) before transplantation and 100 days and 180 days after HCT.


Across 21 transplantation centers, a total of 701 patients consented, underwent transplantation, and were included in the current analyses, 645 of whom were alive at 100 days and 618 of whom were alive at 180 days. Internal consistency reliability was found to be strong for the overall CTXD at the 3 time points: Cronbach alphas (α) were .94, .95, and .95, respectively. Subscale reliability met hypothesized levels of an α>.70 across time, with the lowest reliability noted for the Identity subscale at 180 days (α = .77). Correlations with the SF-36 Mental Health subscale were higher than with the Physical Functioning subscale at each time point, thereby supporting convergent and discriminant validity. Strong correlations of the pretransplantation CTXD with the posttransplantation CTXD and SF-36 Mental Health subscale supported predictive validity.


The CTXD is reliable and valid as a measure of cancer distress both before and after HCT. It may be a useful tool for measuring dimensions of distress and for defining those patients requiring treatment for distress during and after transplantation. Cancer2017;123:1416–1423. © 2016 American Cancer Society.


Although emotional distress is widely recognized as contributing to the suffering of patients with cancer, to the authors' knowledge few measures of the sources and intensity of emotional distress specific to cancer and its treatment have been evaluated in patients over time. In psychometric testing with patients undergoing hematopoietic cell transplantation before transplantation and at 100 days and 180 days after, the Cancer and Treatment Distress measure appears to be reliable and valid, and thus could be useful for tracking multiple dimensions of distress, determining the need for psychosocial treatment, and evaluating response to treatment.

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