A cancer diagnosis can bring distress that may not be visible in routine clinical assessments.

In this episode, Dr. Chirag Jain explores why distress deserves to be recognised, assessed, and addressed as an important part of cancer care.

The Sixth Vital Sign — clinical conversations we need to measure, not overlook.

In Episode 3 of The Sixth Vital Sign, Dr. Chirag Jain examines one of the most overlooked questions in cancer care: How much distress is a patient actually carrying?

In oncology, temperature, pulse, respiration, blood pressure, and pain are routinely measured. But psychological distress often remains invisible because patients may not volunteer it, clinicians may not recognise it, and the question “How are you doing?” can invite a polite “I’m fine” even when the patient is struggling.

This episode introduces the Distress Thermometer, a simple, validated screening tool that asks patients to rate their distress from 0 to 10 and identify the practical, family, emotional, and physical concerns contributing to it. A score of 4 or above commonly signals the need for further assessment.

Dr. Jain explains why distress has been proposed as the sixth vital sign, why cancer clinics still underuse this one-minute screen, and what changes when distress is routinely measured. From hidden anxiety and sleepless nights to fear, family concerns, and difficulty coping with treatment, the episode explores what can remain unseen when clinicians rely only on observation.

Most importantly, the episode makes a clear clinical point: screening only matters when something follows. Measurement must connect to assessment, referral, and appropriate support.

One question. One number. One minute.

Distress is measurable. The question is whether we are measuring it.

In Episode 2 of The Sixth Vital Sign, Dr. Chirag Jain explores scanxiety — the anticipatory anxiety experienced by cancer patients before imaging and, often more intensely, while waiting for results. The scan itself may not be the hardest part. It is the uncertainty surrounding the result, the sleepless nights, repeated checking of the phone, and fear of what the report might reveal.

A 2025 prospective longitudinal study highlighted the scale of the problem, with more than 70% of patients reporting clinically significant anxiety around scans, particularly during the waiting period.

This episode explains why scanxiety is anxiety rather than simply “nerves,” why it can return with every scheduled scan, and how fear of recurrence can become linked to the calendar of follow-up care. Dr. Jain also discusses practical clinical approaches: naming the experience, screening for distress at the right time, and providing appropriate treatment and psychological support.
Scanxiety is common. It is measurable. And it is treatable.

Listen to Episode 2 of The Sixth Vital Sign.