Psychological Distress Common in Patients With Cancer, Nurse Scientist Says

Psychological distress affects a substantial share of patients with cancer, even where supportive care services are in place, according to a retrospective analysis of 21,206 oncology patients at UT Southwestern Medical Center being presented at the 2026 American Nurses Enterprise (ANE) Research Symposium in Chicago.^1,2 Drawing on electronic medical record and tumor registry data from 2023 to 2025, investigators found that 26.4% of patients met the screening threshold for anxiety and 35.8% for depressed mood.¹ In an interview with Oncology Nursing News, lead investigator Yingzi Zhang, PhD, RN, discussed the findings and what they mean for daily nursing assessment.

What was the most critical finding, and how should it shape nursing assessments?

We used [data] across different clinics at UT Southwestern over the past 2 years, from 2023 to 2025. There are a couple of important messages I want to share. First, there is a substantial proportion of patients experiencing anxiety and depression symptoms, which is very alarming to me. [About] 1 in 4 patients met the GAD-7 [threshold] for anxiety, with a threshold of 5, and more than 1 in 3 patients experienced depressed mood measured by the PHQ-9 with a threshold of 5. That is a really large [proportion] of patients who experience psychological [distress].

So I want nurses to know that the psychosocial experience is part of our cancer care. We are not just dealing with physical symptoms. We are not just dealing with removing the tumor for [patients]. We are also dealing with the psychosocial aspect of cancer care. I think oncology nurses—and my background is in oncology nursing as well—have a really good understanding of the psychosocial aspect of the cancer experience. But even though we implement a lot of supportive care services, we still have a large number of patients who experience anxiety and depression.

Of course, we want to do all good things with good intention. The problem I've noticed in my practice and in my research is access. A lot of times we are building a lot of supportive care services, and we do referrals, of course, if [patients] meet the threshold, but not a lot of people go get the service. So maybe access is an issue. I'm not sure, because it was not examined in this study.

Another interesting thing I want to point out is that from our study, we identified a lot of associated factors, such as the primary language [patients] spoke, age, marital status, employment, education, and smoking history, and those are associated with different outcomes. These findings encourage us as nurses to ask people about their social background. This can be an opening for an individualized conversation: What troubles you? What support do you have at home? Do you need any help? Things like that, when we have an encounter with our patients.

One important thing I want to say is that demographic characteristics alone [don't] tell us what support the patient needs, but they may point [to] a question for us to explore. That's the message I want to deliver to the nurses who review my poster.

How can nurses close the gap between high distress and low support service uptake?

Screening is definitely the first step. This is what we do at UT Southwestern: We screen all the patients who walk in the door. We have the NCCN [Distress Thermometer] implemented throughout the comprehensive cancer center, but we don't know if other cancer [centers] have that implemented. I don't have the data to show you that all the patients got that. So screening is definitely step one.

I think a practical way to think about it is to use screening as an opening dialogue, and to assess, as I said, what is troubling the patient, what support [they have], and what their social background is. Can the patient speak English, or do we have really good translators available for them to understand what we are talking about in medical terms? Are there any communication barriers, or any scheduling or financial strain they are experiencing besides cancer? You see the person not just as a patient with cancer; they are a person living with different social factors. Once we recognize those specific individual needs, we can tailor our intervention.

In our cancer center, we have very comprehensive support, but I still see a lot of people who don't go to get it. A very interesting point is that all our supportive care services at UT Southwestern within the cancer center are free, but not every patient who scores high goes to get the service. That's a very interesting topic I want to explore further, to see if there's anything we need to do to help those patients get to the services they need.

What comes next for this research?

The next step I want to take is a follow-up to see what happens after screening. We have a large proportion of patients with psychological symptoms, so [the question is] whether patients receive referrals, whether they connect with the services they need, and what makes the process difficult or easier for them. That's the next study I want to explore.

There are many other studies I can think of. I don't think I have the expertise to do it, but [it's a trending] way to use AI models: put all the associated factors into the model to predict new patients' symptom trajectories. That would be very helpful for us to tailor our interventions to specific timing—whether we can predict a certain period of time during cancer treatment when [patients] experience heightened anxiety or depression. That's the point we should target to provide the service to them. That would be a very interesting topic for someone who has an AI background. But for me, as I said, I want to do a follow-up study to see whether patients get referrals, what services they receive, whether they actually go to use the services, what their feedback is, and any barriers or facilitators in the whole process.

What are the key takeaways for oncology nurses?

• Expect distress to be common. In this analysis, 26.4% of patients screened positive for anxiety and 35.8% for depressed mood (PHQ-9).¹
• Use screening as a conversation starter. Zhang recommends pairing distress screening with questions about what is troubling the patient and what support is available at home.
• Treat social factors as prompts, not conclusions. Non-English primary language, marital status, employment, education, smoking history, and younger age were associated with distress, but demographics alone do not identify an individual patient's needs.¹
• Confirm language access. Check that interpreters are available so patients understand medical information, and ask about communication, scheduling, and financial barriers.
• Recognize distress beyond scores. Emotional distress can surface as changes in sleep, appetite, or behavior, and referral to oncology social work is one route to support, as discussed in previous Oncology Nursing News coverage.³
• Reassess over time. A study of 108 patients with metastatic breast cancer found that quality of life dropped on days when depression and anxiety ran worse than usual.⁴
• Follow up after referral. At UT Southwestern, supportive care services are free, yet not every patient with a high score uses them; confirming whether patients connect with services may help close that gap.

This interview has been edited for clarity and length.

References

1. Zhang Y, Cunningham A, Atem F, Huffman A, Keely K, Mullins MA. Psychological distress and associated factors among oncology patients: a large-scale analysis. Poster presented at: American Nurses Enterprise Research Symposium; October 28, 2026; Chicago, IL.
2. Research Symposium 2026: discovery to impact: advancing research for a healthier future. American Nurses Enterprise. Accessed October 23, 2026. https://magnetpathwaycon.nursingworld.org/research-symposium-2026
3. Bridging the distress gap: connecting oncology patients to social work. Oncology Nursing News. August 14, 2026. Accessed October 23, 2026. https://www.oncnursingnews.com/view/bridging-the-distress-gap-connecting-oncology-patients-to-social-work
4. Daily symptom shifts linked to quality of life in metastatic breast cancer. Oncology Nursing News. October 8, 2026. Accessed October 23, 2026. https://www.oncnursingnews.com/view/daily-symptom-shifts-linked-to-quality-of-life-in-metastatic-breast-cancer