Understanding, screening, and providing resources for quality of life factors and psychosocial distress have become an important area of focus in cancer care. Negative consequences of poor quality of life and psychosocial distress have been widely studied in oncological research. The National Comprehensive Cancer Network, or NCCN, defines "psychosocial distress" as extending on a continuum, "ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis" ("National Comprehensive Cancer Network," n.d.). Findings have indicated the significant impact of poor quality of life and psychosocial distress in the cancer patient population. Elevated levels of psychosocial distress increases the risk of developing depression, anxiety, immune suppression, and may lead to high levels of stress. Studies have also revealed associations between increased psychosocial distress levels, relapse, treatment and healing outcomes, and survival rates (Anderson, Kiecolt-Glaser, & Glaser, 1994; Spiegel & Nemeroff, 1997). Evidence also shows that heightened psychosocial distress negatively influences a patient's capability to adhere to their medical plan and treatment (Allison et al., 1995; Pirl et al., 2007; Zabora, Brintzenhofeszoc, Curbow, Hooker, & Piantadosi, 2001). Attending to these negative outcomes of psychosocial distress and providing supportive care is a crucial action of oncology practice today. The American College of Surgeons Commission on Cancer responded to the imperative of addressing psychosocial needs in cancer care by mandating national cancer centers for accreditation purposes to screen for psychosocial distress and provide appropriate referral and resources (Standard 3.2). UF Health Cancer Center – Orlando Health began psychosocial distress screening on January 1st, 2015 with the utilization of the Web-based, HIPPA compliant, and action based Cancer Support Source Program. Patient data responses collected with the Cancer Support Source Program over the first calendar year of the implementation of the American College of Surgeons Commission on Cancer standards were analyzed for this research study. A sample of 317 patient data responses was included to conduct an exploratory factor analysis (EFA) on the Cancer Support Source Program test items. Specifically, a Principal Component Analysis (PCA) with an oblique rotational procedure (Promax) was conducted on the resulting data set for interpretation. Factorial interpretation was made to ascertain latent dimensions in the Cancer Support Source Program. A five factor structure model was found with adequate discriminant and face validity. Factors were grouped by conceptual basis and item-loading composition: Distress, Treatment Management and Decisions, Lifestyle, Relationship, and Substance Use. These factors were collectively termed the Concern Subscales. The Distress, Treatment Management and Decisions, and Lifestyle Factors were found to present the most psychometrically sound and internally consistent model. Further analysis was conducted to examine the resulting factorial structure model on four cancer location groups: breast, head and neck, lung, and gynecological cancer. Results displayed that no significant differences were found between cancer location groups and the five extracted factors. However, an ad hoc test (Tukey's HSD) revealed two significant differences between the Lifestyle Factor and cancer location groups at the p < 0.05 level. The Breast Cancer group's Lifestyle scores were higher than the Gynecologic Cancer group, and the Breast Cancer group scores were lower than the Lung Cancer group. Additionally, the action scores were summed to examine correlation between the five extracted Concern Subscales. A high correlation was found, indicating that the action items in the Cancer Support Source questionnaire correspond with the extracted Concern Subscales and do not need to undergo dimension reduction. Furthermore, a high correlation was also found with the extracted Distress Concern Subscale and the existing depression subscale in the Cancer Support Source Program. Results indicated that the Cancer Support Source Program could indeed benefit from dimension reduction to ascertain more parsimonious areas of need presented by the cancer patient population. The 25 single-items in the Cancer Support Source questionnaire may inhibit the ability to indicate other concerns that may be expressed by the patient. By identifying the latent dimensions in this exploratory endeavor, we were able to demonstrate how the Cancer Support Source questionnaire could be refined to include easily scored Concern subscales to better identify areas of need for each individual patient that is screened for psychosocial distress. These findings provide an opportunity to impact patient care, opportunities for referral, and resources for cancer care in a hospital setting using this psychosocial distress screening instrument.


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Graduation Date





Cassisi, Jeffrey


Master of Arts (M.A.)


College of Sciences



Degree Program

Psychology Clinical









Release Date

May 2017

Length of Campus-only Access


Access Status

Masters Thesis (Open Access)