Abstract
Little is known about symptom burden-a concept encompassing both symptom severity and the degree of symptom interference with daily living-in patients with cancer in Morocco or other countries with Arabic-speaking populations. The goal of this study was to psychometrically validate the Arabic version of the M. D. Anderson Symptom Inventory (MDASI-A), a tool for measuring multiple symptoms in patients with cancer, and to test its utility in a sample of patients with late-stage cancer in Morocco. The MDASI-A was developed by standard forward-backward translation of the English MDASI. We used nonidiomatic Arabic in the MDASI-A to enhance its possible usefulness for all Arabic-speaking patients with cancer. One hundred sixty-five Arabic-speaking patients with various cancer types were recruited from a city hospital in Rabat, Morocco. The MDASI-A was administered by interview, as only 5% of the patients had a high school education. Psychometric analysis demonstrated acceptable internal consistency, with Cronbach alpha values of 0.85 for all 19 items, 0.78 for symptom severity items, and 0.79 for interference items; known-group validity was demonstrated by significant differences in mean symptom severity and interference between patients with good vs. poor performance status. All patients had moderate to severe pain and were taking pain medications. Additional severe symptoms included fatigue, lack of appetite, and disturbed sleep. Patients with gastrointestinal or gynecological cancer reported relatively more symptom severity than patients with breast or lung cancer. Poor performance status, male gender, and current infection were significant predictors of high symptom interference (R(2)=0.48, P<0.05). The MDASI-A is a valid and reliable patient-reported outcome instrument that can be used to assess Moroccan Arabic-speaking cancer patients' multiple symptoms. Its utility for use in other Arab countries needs to be tested.
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