Screening for Distress Among Metastatic Breast Cancer Patients: Implementation and Validation of the NCCN Distress Thermometer in Southwest Nigeria

Background Metastatic 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. Objective This 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. Methods A 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. PD was defined as a DT score ≥ 4. Sociodemographic, clinical, and psychosocial data were retrieved from electronic medical records. Results The 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. Conclusion Addressing stigma and resource limitations is vital to optimize supportive care and improve clinical outcomes. Psychological distress is highly prevalent among MBC patients in this LMIC setting, characterized by complex interactions between practical challenges, psychological symptoms, and physical manifestations. The DT proved effective in identifying at-risk individuals, underscoring the need for routine psychosocial screening in oncology care. Implementation of integrated supportive care programs addressing both practical and psychological needs, alongside strengthening of healthcare system resources, is vital to optimize patient outcomes.