Preliminary guidelines for the treatment of distress

The National Comprehensive Cancer Network (NCCN) has provided those working in psycho-oncology with an important opportunity to examine the unique issues that relate to the development of psychological treatment guidelines. There are special problems in managing distress and in developing guidelines for its management. First, we need a nonstigmatizing word that encompasses all levels of psychological problems--from those considered "normal" to diagnosable psychiatric disorders. Distress is an example of such a word that can be used for a range of problems. It is objective and nonjudgmental. Attitudes of patients, staff, and institutions about psychological issues have created barriers to the prompt recognition and treatment of distressed patients. The major issue for implementation is the development of ways to rapidly identify distressed patients and triage them to the proper level of mental health intervention. A national plan by a multidisciplinary consortium, such as the NCCN, should be developed to recommend an agenda for clinical, educational, and research activities.