High Prevalence and Multidomain Predictors of Clinically Significant Distress in a Tertiary Oncology Center in Iraq: A Cross-Sectional Study Using the NCCN Distress Thermometer

Abstract

Background: Cancer-related distress is a multidimensional construct that may compromise coping and engagement with care. Routine screening using the NCCN Distress Thermometer (DT) and Problem List is recommended to identify patients requiring timely supportive interventions. This study quantified distress burden and its predictors in Al Anbar Cancer Center, Iraq.

Materials and Methods: We conducted a cross-sectional analysis of consecutively screened oncology patients using the NCCN DT (0–10) and Problem List. The primary endpoint was the prevalence of clinically significant distress (DT ≥4). DT was additionally analyzed as a continuous outcome. Domain-burden variables (physical, emotional, practical, spiritual/religious, family) were computed as counts of endorsed items. Associations were examined using Spearman correlation and Kruskal–Wallis testing. Multivariable linear regression modeled DT intensity, and logistic regression identified predictors of DT ≥4.

Results: A total of 264 patients were analyzed (mean age 53.54 ± 13.45 years; range 17–91) of whom 84.47% were female. Breast cancer was the most frequent diagnosis (47.73%), followed by gastrointestinal/hepatobiliary (15.15%) and hematologic malignancies (13.64%). Median DT score was 6.00 (IQR 3.00–8.00), and 73.48% (n=194) screened positive for DT ≥4. Problem domains were commonly endorsed: physical 79.55%, emotional 74.24%, practical 60.61%, spiritual/religious 30.30%, and family 9.85%. DT score was not associated with age in bivariate analysis (p = 0.403) and did not differ significantly by gender (p = 0.394), but it varied significantly across tumor types (p = 0.002). DT intensity correlated most strongly with physical-domain burden (p < 0.001). In logistic regression for DT ≥4, higher physical-domain burden markedly increased the likelihood of clinically significant distress (95% CI 4.81–25.64, p < 0.001), with additional contributions from emotional burden (95% CI 1.23–3.30, p = 0.005) and spiritual/religious burden (95% CI 1.57–39.79, p = 0.012).

Conclusion: Distress burden was high in cancer patients in Iraq, with nearly three-quarters screening positive at DT ≥4. Physical symptoms emerged as the primary driver of both distress intensity and screening positivity, supporting an integrated distress management approach that links symptom control with psychosocial, practical, and spiritual support.