Clinical Summary

• Qualitative interviews revealed varied patient interpretations of “stress” and “distress” during cancer treatment.
• Some patients viewed distress as a more intense or physical form of stress, while others saw no difference between the terms.
• Findings suggest oncology nurses may need to reconsider how distress screening terminology is used in clinical practice.

Patients with cancer frequently experience psychological distress throughout the treatment trajectory, yet how they personally define “stress” and “distress” remains poorly understood. A qualitative study presented at the 2026 Oncology Nursing Society (ONS) Congress explored how patients receiving radiation therapy interpret these commonly used clinical concepts.

The ongoing mixed-methods study included semi-structured telephone interviews conducted between January 2021 and June 2022. Researchers analyzed preliminary data from 20 participants enrolled in the larger study. Interviewees ranged in age from 38 to 84 years, with a mean age of 62.3 years. Most participants were female (65%), and cancer diagnoses included breast, prostate, endometrial, and other malignancies.

Investigators used descriptive and in vivo coding methods to analyze interview transcripts. Questions focused on participants’ understanding of stress, distress, and perceived differences between the two concepts.

Several major themes emerged. Many participants described distress as a more severe or amplified version of stress. One participant characterized distress as “an amplified version of stress.” Others reported no meaningful distinction between the terms. Some participants differentiated the concepts by describing stress as primarily mental and distress as physical. Illustrative responses included statements such as “Distress maybe feeling physically ill” and stress being “something that’s stressing you out or something that’s hard to manage.”

Researchers also found that some participants confused “distress” with “de-stress,” associating the term with calming or relaxation rather than psychological burden.

The findings suggest that patients may not conceptualize stress and distress in the same way clinicians or validated screening tools define them. Because oncology nurses routinely use distress screening measures, differing patient interpretations could affect symptom reporting and supportive care assessments.

Clinically, the study highlights the importance of clear communication during psychosocial screening in oncology settings. If patients interpret distress differently than intended, clinicians may need to adjust terminology or provide additional explanations to ensure accurate assessment of emotional well-being.

The authors noted that patients often “use elements of both definitions to represent feelings of uneasiness and dread,” while describing distress as either “worse than stress” or “a physical manifestation of stress.”

Investigators suggested that future nursing research should further evaluate whether patients perceive the concepts similarly and whether supportive care approaches should adapt accordingly.

Overall, the study underscores the complexity of psychosocial terminology in cancer care and raises questions about how distress screening language is understood by patients undergoing treatment.

Source: 

Haynes-Lewis H, Bloom R, Jiang J, Garg M, Kalnicki S. Stress and Distress is There a Difference. Presented at the Oncology Nursing Society Annual Congress; May 13-17, 2026. San Antonio, TX.