Different treatments, different minds: The overlooked side of ovarian cancer care

Table 1 Validated psycho-oncology screening tools and recommended referral pathways

Tool/instrument	Purpose and setting	Administration period/items	Common cut-off(s)	Referral pathway/recommender immediate action	Key evidence and notes	Implementation barriers	Ref.
Notes for local adaptation	Translate and culturally adapt tools; pilot test acceptability	Cognitive testing and brief pilot	Transparent adaptation with translation, testing and piloting that confirms credibility uptake	Include caregiver modules and measure caregiver burden	Cultural framing enhances uptake; family-inclusive work addresses caregiver distress parallel to patient outcomes	High-income: Language and cultural fit well supports. Low/middle-income: Need translation, piloting and cultural adaptation before rollout	[5]
Delivery models	Scalability options for low and middle-income countries/rural areas	Nurse-delivered brief CBT, digital/telehealth CBT, group MBSR	N/A (model selection based on resources)	Use stepped-care matching patient severity to intervention intensity; plan supervision and fidelity checks	Task-sharing and telehealth demonstrate feasibility and efficiency in psycho-oncology and low and middle-income countries adaptation literature	High-income: Multidisciplinary teams available. Low/middle-income: Depend on nurse-led or telehealth models; training gaps common	[51,52]
PHQ-9	Depression screening across oncology settings (e.g., survivorship clinics, outpatient)	About 2 minutes to 5 minutes self-report or clinician-administered; 9 items	Typical threshold: ≥ 10 (moderate). Local program may use ≥ 10/≥ 15 for stepped care. Sensitivity 63% and specificity 77% in cancer populations	Positive: Brief psychological triage within 24 hours; PHQ-9 ≥ 10: Enroll in brief digital CBT/CBT or nurse-led program within 72 hours; PHQ-9 ≥ 15 or suicidal idea: Urgent psychiatric evaluation and safety plan within 24 hours	Two-step screening feasibility/validation in cancer, including PHQ-9 performance. Validated in oncology/ovarian cancer cohorts	High-income: Quick access to psychologist within 72 hours. Low/middle-income: Few specialists; nurse-led triage or remote consultation may take 1-2 weeks	[41]
GAD-7	Screening for generalized anxiety and panic symptoms during treatment and follow-up	About 2 minutes to 5 minutes; 7 items	≥ 10 indicates clinically efficient anxiety. Sensitivity: 25% to 77.8% and specificity 86.5% to 95.4%	GAD ≥ 10: Provide targeted psychological therapy (CBT/MBSR) within 7 days, monitor and escalate to psychiatry if chronic or comorbidities	Diagnostic accuracy and feasibility assessments of GAD-7 in cancer patients. Validated in oncology settings	High-income: Individual CBT available within 2 weeks. Low/middle-income: Often depend on short counseling or dig CBT; longer waits times	[42,43]
FCRI-SF	Focused screening for FCR at transition stages and survivorship	About 3 minutes to 5 minutes; short-form (severity sub-scale) about 9 items	Apply validated cut-points from validation studies; use established threshold validation to detect clinically efficient FCR (use local validation). Sensitivity: 90%; specificity: 83.3%	Positive/high score: Referral to FCR-focused CBT or short FCR group intervention; consider psycho-education and family involvement	Recent large-sample work validating FCRI-SF screening ability and prevalence. Validated in oncology settings	High-income: Structured FCR program exist. Low/middle-income: Use brief group or online sessions due to limited trained experts	[44,45]
NCCN distress thermometer and problem list	Fast triage across clinics; international translations available for worldwide application	< 2 minutes; single 0-10 thermometer and problem checklist	Score ≥ 4 or local threshold. Sensitivity: 100%; specificity: 72.3%	Score above threshold: Problem-driven referral pathway (e.g., palliative care, psychiatry, psychology, and social work) within 72 hours	Recent decision tree validation and update studies in breast/other cancer studies. Validated in gynaecologic cancer settings	High-income: Fast referral to psychosocial staff. Low/middle-income: Limited staff; use brief counseling or phone follow-up instead	[46,47]
EORTC QLQ-C30	Comprehensive QOL measurement for program assessment and trials	5-8 minutes, used as an outcome measure rather than a fast screen; 30 items	Not a screening tool; use for baseline and result evaluation in trials	Use as a secondary result for psychological intervention trials and to measure functional alteration	Gold standard QOL measure in oncology trials; recommended for trial endpoints	High-income: Used routinely for trials and audits. Low/middle-income: Limited use due to staff workload and data-entry complications	[48]
Operational items/implementation	Stepped-care linkage and system readiness	Track: Screening coverage, fidelity, uptake, time-to-intervention, and cost per patient	Pre-specified targets (e.g., > 80% screening coverage; time-to-intervention < 2 weeks)	Required: Named psychological lead, referral protocols, and supervision plans for task-sharing employees	Implementation parameters align with guideline recommendations and the implementation science framework	High-income: HER systems permit rapid monitoring. Low/middle-income: Manual monitoring; less trained staff cause delays	[49,50]

PHQ-9: Patient Health Questionnaire-9; CBT: Cognitive-behavioral therapy; N/A: Not applicable; GAD-7: Generalized Anxiety Disorder 7-item; MBSR: Mindfulness-based stress reduction; FCRI-SF: Fear of cCancer Recurrence Inventory-Short Form; FCR: Fear of cancer recurrence; NCCN: National Comprehensive Cancer Network; EORTC QLQ-C30: European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; QOL: Quality of life.