Memorial Symptom Assessment Scale-Short Form Research Articles

Differential effects of patient symptom subtypes on informal hospice caregiver depression.

Informal caregivers recruited from a not-for-profit community-based hospice agency participated in a cross-sectional survey. Self-report questionnaires assessed caregiver burden associated with patient symptomatology (via a modified version of the Memorial Symptom Assessment Scale-Short Form) and caregiver depressive symptoms, including suicidal ideation (measured by the Patient Health Questionnaire-9). Multiple regressions evaluated the unique predictability of patients' symptom subtypes on caregiver depression. Exploratory analyses examined mean differences of study variables between participants who did and did not endorse suicidal ideation. Caregiver burden related to patients' psychological symptoms accounted for significant variance in caregiver depression scores when controlling for burden related to physical symptoms. Among 229 caregivers (M age = 61.4 years), 12 reported suicidal ideation, where 6 of the 12 were male, despite male caregivers comprising less than 20% of the total sample. Burden associated with patients' psychological symptoms uniquely contributed to caregiver depression, further highlighting the clinical utility and necessity for hospice providers to address the emotional needs of patients and their caregivers alike. Developing clinical procedures to identify and respond to such needs would not only behoove hospice agencies, but it would likely enhance the caregiving experience holistically, which might be particularly imperative for male caregivers.

Symptom Burden in Advanced Soft-Tissue Sarcoma

ContextThere is little information on symptom prevalence and severity in advanced soft-tissue sarcoma (STS). Understanding symptom burden will aid clinical consultations, clarify which symptom interventions are needed, and better define optimum timings of palliative and supportive care referrals. ObjectivesTo describe symptom prevalence and severity in patients undergoing different treatment options for advanced STS: 1) first-line palliative chemotherapy (FLC), 2) active surveillance (AS) pre- and post-FLC, and 3) palliative care (PC) alone. MethodsCross-sectional survey in one sarcoma center using the patient-reported Memorial Symptom Assessment Scale–Short Form (MSAS-SF). Symptom prevalence, severity, and MSAS-SF subscales were recorded before commencing a new treatment. Our results were compared with other MSAS-SF cancer and noncancer data. ResultsOne-hundred and thirteen patients (mean age, 59 years) were recruited. Forty-two commenced FLC, 27 started AS pre-FLC, 24 AS post-FLC, and 20 PC alone. Median overall number of reported symptoms was 11 (range 1–31): which when stratified by treatment meant AS pre-FLC < AS post-FLC < FLC < PC alone (most symptomatic). The commonest physical symptoms were pain (77%; 95% CI 68–84), lack of energy (73%; CI 63–81) difficulty sleeping (56%; CI 46–65), feeling bloated (49%; CI 39–58), and dyspnea (49%; CI 39–58). Distress levels were commensurated with prevalence except for dyspnea, which was disproportionally less distressing. Psychological distress was moderate (mean MSAS-PSYCH: 1.39) but higher than comparative cancer data. ConclusionAdvanced STS patients have a clinically important symptom burden comparable to other cancers. Common symptoms should be screened and addressed appropriately, including timely PC involvement.

Factors influencing the quality of life of patients with advanced cancer

The present study aimed to determine the predictors of quality of life (QOL) of patients with advanced cancer. A cross-sectional study involving 494 patients with advanced cancer was conducted using the Memorial Symptom Assessment Scale-Short Form, the Karnofsky Performance Status Scale, the World Health Organization Disability Assessment Schedule (Korean version), and the European Organization for Research and Treatment of Cancer Quality of Life Core 30. Regression analyses showed that physical and psychological symptoms significantly predicted the patients' QOL and explained 28.8% of the variance in QOL. Moreover, lack of energy was the patients' most prevalent symptom. The results of the present study will serve as fundamental data upon which the development of an intervention will be based so as to enhance the patients' QOL. Accordingly, an effective management of symptoms and performance maintenance should be considered in the future as key factors in providing support and establishing palliative care systems for patients with advanced cancer.

The Prevalence and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure Attending a South African Medical Center.

Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.

Use of Mindfulness Sitting Meditation in Chinese American Women in Treatment of Cancer.

Background. Very few studies have been conducted to examine the prevalence, frequency, perceived effectiveness, and possible influencing factors of use of meditation in patients with cancer. Objectives. To examine use of mindfulness sitting medication (MSM) in Chinese American women in treatment of cancer, its relationship to specific symptom distress, and possible influencing factors of MSM. Methods. Volunteer participants were recruited through the American Cancer Society support groups. The participants completed a demographic data form, a researcher-developed criteria and checklist for MSM, and the Memorial Symptom Assessment Scale–Short Form. Results. Eighty-nine Chinese American women with a mean age of 58 years completed the questionnaires. Twenty-one patients (24%) reported the use of MSM during active treatment of cancer. Patients who had higher education, better income, better English proficiency, and health insurance were more likely to use MSM. Patients who had more symptom distress also reported to use more MSM. Most patients (20/21) who used meditation considered it effective. After controlling other variables, better English proficiency, breast cancer, and higher symptom distress predicted the use of MSM in Chinese American women in treatment of cancer. Conclusions. About 24% of Chinese American women used MSM in the treatment of cancer and most of them considered it effective. Symptom distress and English proficiency levels predicted the use of MSM. Implications for Practice. Given the effectiveness of MSM, oncology nurses could recommend using MSM in Chinese American women in treatment of cancer, especially for patients who had higher symptom distress.

Symptom burden in cancer patients and caregiving experience

Introduction Cancer patients typically experience multiple physical and psychological symptoms that may result from the disease or from treatment. The most common are pain, depression, anxiety, fatigue, insomnia, breathlessness, nausea, constipation, diarrhea and anorexia. The high symptom burden profoundly affects the patient but also the caregiver, which frequently experiences anxiety and depression. Objectives Identify a correlation between patient symptoms and caregiver emotional disturbances. Aims The aim of the present study was to improve the identification of vulnerable family caregivers who could require psychotherapeutic and psychopharmacological support. Methods For this purpose, all eligible patients and caregivers were approached during a regularly scheduled patient clinic visit at a Portuguese psycho-oncology unit. Data was collected using the Memorial Symptom Assessment Scale-Short Form and Depression Anxiety Stress Scale-21. Sociodemographic and clinical data were also collected. Statistics were performed with SPSS. Results High levels of psychopathology in caregivers were associated with female caregiver sex and worse patient physical and emotional well-being. Uncontrolled pain was related with high scores in DASS-21. Conclusions Cancer patient's caregivers experienced high levels of anxiety and depression associated with worse patient well-being. The psychological stress of caregiving has a negative impact not only on the health of the caregivers but also on cancer patients. Early interventions directed at patient symptoms and caregiver support may improve quality of life in this population.

Symptom Burden and Functional Dependencies Among Cancer Patients in Botswana Suggest a Need for Palliative Care Nursing.

Palliative care and cancer nursing in sub-Saharan Africa is hampered by inadequate clinical resources and evidence base but is central to symptom management amid the growing cancer burden. The aim of this study is to describe symptom burden and functional dependencies of cancer patients in Botswana using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) and Enforced Social Dependency Scale (ESDS). A cross-sectional multisite study was conducted in Gaborone, Botswana, from June to August 2013 using MSAS-SF, ESDS, and Eastern Cooperative Oncology Group (ECOG) performance status at 1 time point. Descriptive statistics, tests of association, correlation, and scale validity were used. Among the 100 cancer patients, 65 were women, 21 were inpatients, 48 were human immunodeficiency virus-positive, 23 had gynecological malignancies, 34 had stage 4 disease, and 54 received chemotherapy only. Sixty-four reported pain; 54, neuropathies; 51, weight loss; and 51, hunger. Most distressing symptoms were weight loss, body image, skin changes, and pain. Recreational/social role was most affected by cancer. Cronbach's α for both the MSAS-SF and ESDS was .91. Variations in means for MSAS-SF and ESDS were associated with ECOG grade 2 (P < .05); the ECOG moderately correlated (0.35) with MSAS-SF (P < .01). No associations with human immunodeficiency virus status were found. Patients reported distressing levels of cancer pain, weight loss, hunger, and dependency in recreational/social activities. The Setswana translations of the MSAS-SF and ESDS were found reliable to assess cancer patients' symptoms and function. Nurses trained in palliative care are needed to meet cancer patients' pain and symptom management care needs.

Prevalencia y evaluación de síntomas en enfermedad renal crónica avanzada

El paciente con enfermedad renal crónica avanzada (ERCA) presenta una elevada carga de síntomas que contribuyen a un aumento del sufrimiento y disminuyen su calidad de vida. El uso de instrumentos de evaluación es esencial para el control de síntomas. El objetivo de esta revisión es obtener una visión contrastada de los instrumentos más usados para evaluar síntomas en ERCA, realizando una descripción de la prevalencia de síntomas en esta población. Método: Se realizó una revisión de la literatura publicada sobre estudios en los que se utilizara algún instrumento para medir la intensidad de varios síntomas en pacientes con ERCA. La búsqueda se realizó en Pubmed, Cochrane, SciELO, TESEO, PROQOLID y BiblioPRO. Los criterios de inclusión fueron: estudios realizados con pacientes en ERCA, que evaluaran la sintomatología con algún instrumento de medición de síntomas, y que además, indicaran la prevalencia de varios síntomas. Resultados: Los instrumentos identificados fueron el Memorial Symptom Assessment Scale Short Form(MSAS-SF), el Dialysis Symptom Index (DSI), el Edmonton Symptom Assessment System (ESAS) y el Palliative care Outcome Scale-Symptoms Renal (POS-S RENAL). En pacientes adultos con ERCA sometidos a tratamiento renal sustitutivo con hemodiálisis y diálisis peritoneal, los síntomas más prevalentes fueron el cansancio, prurito, estreñimiento, anorexia, dolor, alteraciones del sueño, ansiedad, disnea, nauseas, piernas inquietas, y depresión. Éstos síntomas fueron similares en pacientes con manejo renal conservador, y presentaron un patrón común con la sintomatología de otras enfermedades avanzadas. Concluimos que existe necesidad de investigar sobre prevalencia y evaluación de síntomas en esta población, y que el uso sistemático de los instrumentos específicos de evaluación de síntomas como medida de resultados es fundamental.

Illness perceptions among cancer survivors.

The purpose of the study is to document in Hong Kong Chinese cancer survivors cross-sectional associations between illness perceptions, physical symptom distress and dispositional optimism. A consecutive sample of 1036 (response rate, 86.1%, mean age 55.18 years, 60% female) survivors of different cancers recruited within 6 months of completion of adjuvant therapy from Hong Kong public hospitals completed the Brief Illness Perception Questionnaire (B-IPQ), Chinese version of the Memorial Symptom Assessment Scale Short-Form (MSAS-SF), and the revised Chinese version of Life Orientation Test (C-LOT-R), respectively. Stepwise multiple regression analyses examined adjusted associations. IPQ seriousness, symptom identity, illness concern, and emotional impact scores varied by cancer type (p < 0.01). Stress-related, lifestyle, environment, psychological/personality, and health-related factors were most frequently attributed causes of cancer. After adjustment for sample differences, physical symptom distress was significantly associated with all illness perception dimensions (p < 0.01), excepting control beliefs. Optimism was positively correlated with perceived personal and treatment control (p < 0.01) and illness understanding (p < 0.01), but negatively correlated with other IPQ dimensions (all p < 0.01). IPQ domain differences by cancer type were eliminated by adjustment for sample characteristics. Illness perceptions did not differ by cancer type. Greater physical symptom distress and lower levels of optimism were associated with more negative illness perceptions. Understanding how cancer survivors make sense of cancer can clarify an important aspect of adaptation. This in turn can inform interventions to facilitate adjustment. Knowledge contributions include evidence of physical symptom distress correlating with most dimensions of illness perception. Optimism was also associated with cancer survivors' illness perceptions.

Nursing intervention to enhance outpatient chemotherapy symptom management: Patient-reported outcomes of a randomized controlled trial.

The authors conducted a randomized controlled trial to evaluate a nurse practitioner (NP)-delivered symptom management intervention for patients initiating chemotherapy for nonmetastatic cancer. The aim was to reduce patient-reported symptom burden by facilitating patient-NP collaboration and the early management of symptoms. At the time of the first chemotherapy visit, adult participants with nonmetastatic breast, colorectal, or lung cancer (120 participants) completed self-report measures and were then randomly assigned to standard care plus the intervention or standard care alone. Intervention participants received proactive telephone calls from their oncology team NP during the week after each of the first 2 chemotherapy administration visits. Measures were repeated at the second and third chemotherapy visits. Group differences were analyzed with regard to patient-reported symptoms (Memorial Symptom Assessment Scale-Short Form items), satisfaction with care (Family Caregiver Satisfaction-patient scale), and the likelihood of depression or anxiety symptoms (Patient Health Questionnaire-4). At the time of the first visit, 50.8% of participants reported ≥1 physical symptom, most commonly lack of energy (35.8%) and drowsiness (30.8%). The number of symptoms (gamma coefficient [γ] = 0.16; P<.001), symptom distress (γ = 0.45; P<.001), and satisfaction with care (γ = 0.24; P = .004) increased whereas the likelihood of anxiety symptoms decreased (γ = -0.19; P = .02) and the likelihood of depression symptoms did not change (γ = 0.01; P = .91). Outcomes did not differ by randomized group. Randomized group interacted with emetogenic potential in predicting symptom distress (γ = 0.43; P = .03) and satisfaction with care (γ = -0.45; P = .045). The intervention did not appear to reduce symptom burden compared with standard care. Early symptoms highlight the importance of continuing to examine strategies to improve symptom management during chemotherapy for nonmetastatic disease.

Patient-Reported Outcomes for Determining Prognostic Groups in Veterans With Advanced Cancer

ContextPhysicians overestimate survival in patients with advanced cancer. Patient-reported outcomes could provide another way to estimate survival. We previously reported four prognostic groups based on Karnofsky Performance Status, Functional Assessment of Cancer Therapy physical well-being subscale, and Memorial Symptom Assessment Scale-Short Form physical symptom distress subscale scores. ObjectivesTo determine the validity of these four prognostic groups. MethodsWe performed prospective surveys. Data from a total of 880 Veterans Affairs Medical Center patients, 417 in the First Cohort and 463 in the Validation Cohort, were analyzed. Both inpatients and outpatients were prospectively recruited in Institutional Review Board-approved studies from August 1999 to September 2009. Survival was measured from the date of entry until death or December 1, 2009. Patients completed self-assessments with the Functional Assessment of Cancer Therapy and Memorial Symptom Assessment Scale-Short Form. Analysis of variance was used to test differences between groups in continuous variables; a generalized Wilcoxon test was used for differences between groups for survival. ResultsThe average age in the Validation Cohort was 66.5 years and 98% were men. The majority of patients had metastatic cancer (90%), with lung (28%) and prostate (26%) cancers being predominant. The median Karnofsky Performance Status was 70. Median survival was 33, 46.5, 124, and 209.5 days for the four prognostic groups (P < 0.0001, all pair-wise comparisons P < 0.02). ConclusionThe four prognostic groups remained distinct in the prospective cohort. Small differences in patient-reported physical well-being can halve survival estimates. Patient-reported outcomes can correct for physician overestimate of prognosis. This study provides a way to use patient-reported outcomes for prognosis in patients with advanced cancer, with important implications for assessment.

Changes of Symptom Distress and Quality of Life in Breast Cancer Patients Receiving Adjuvant Therapy

Purpose: The purpose of this study was to identify changes of symptom distress and quality of life (QOL) in breast cancer patients receiving adjuvant therapy. Methods: 113 patients with breast cancer were administered the Memorial Symptom Assessment Scale-Short Form and the Functional Assessment of Cancer Therapy?Breast before adjuvant therapy, both a week and 6 months after completing adjuvant therapy. 71 patients (CTx group) were treated with adjuvant chemotherapy and radiotherapy. 42 patients (RTx group) received only adjuvant radiotherapy. Data were analysed using the SPSS/Win 21.0 program. Results: Compared with the RTx group, patients in the CTx group reported higher overall symptom distress and physical symptom distress. The CTx group reported lower scores in overall QOL, physical well-being and the breast cancer specific domain than the RTx group. Conclusion: Findings from this study support that chemotherapy results in higher risk for more severe symptoms and leads to impaired QOL for breast cancer patients. Comprehensive symptom management should be implemented for breast cancer patients receiving chemotherapy.

Symptom distress and its association with traditional Chinese medicine use in Chinese American women with cancer.

To identify symptom distress related to cancer for a group of Chinese American women in treatment, and to examine their use of various forms of traditional Chinese medicine (TCM) and their relationships to specific symptoms they identified. Cross-sectional, correlational. American Cancer Society Asian Initiatives support groups in the state of New York. 97 Chinese American women residing in New York with a mean age of 57 years; the time since diagnosis of cancer ranged from two months to 24 years. The type of diagnosis for the majority of women was breast cancer. A self-reported questionnaire including a demographic data form, a researcher-developed checklist for types of TCM, and the Memorial Symptom Assessment Scale Short Form (MSAS-SF) were administered. The MSAS-SF has three subscales: global distress index, psychological symptom distress scale, and physical symptom distress scale. Symptoms, symptom distress, and types of TCM. The descriptive statistics and Mann-Whitney U tests were applied for data analysis. Chinese American women with cancer in treatment reported multiple symptoms, and the three MSAS-SF distress subscale scores indicated moderate symptom distress. Symptoms were positively associated with the use of TCM. Chinese American women in treatment for cancer reported multiple symptoms and moderate symptom distress. Participants with specific symptoms tended to use specific forms of TCM. High prevalence of psychological symptoms for Chinese American women with cancer suggests that oncology nurses should work with mental health providers for symptom management of this population. Oncology nurses also need to stay informed of the growing body of evidence on the benefits of TCM for patients with cancer. Future studies should include an emphasis on the improvement in methodologic quality for studies that investigate using TCM in participants with cancer.

Patient-reported outcomes for determining prognostic groups in veterans with stage IV solid tumors starting systemic therapy.

48 Background: A Recursive Partitioning Analysis (RPA) prognostic algorithm based on quality of life and symptoms predicted 4 groups with distinct median survivals in patients with metastatic solid tumors receiving chemotherapy (ASCO 2013, Abst 9567). We update our findings. Methods: The RPA algorithm is based upon Karnofsky performance status (KPS), Functional Assessment of Cancer Therapy (FACT) physical well-being (PWB) subscale, and Memorial Symptom Assessment Scale Short Form (MSAS-SF) physical symptom distress (PHYS) subscale. Starting in 2007, a convenience sample of Veterans who were prescribed systemic treatment for their cancer was enrolled in an IRB approved protocol, and completed quality of life (FACT- G) and symptom (MSAS SF) questionnaires at the first cycle of treatment. We analyzed records of patients with stage IV metastatic solid tumors enrolled through June 2013, and determined survival as of June 15, 2014. Analyses were performed with STATA 11.0. Results: There were 97 patients(pts). The median age was 64 yrs, range 27-88. Males comprised 95 (98%) pts. First line chemotherapy was given to 78 (80%) pts. The most common primary sites were lung cancer 33 (35%), prostate 17 (17%) and colon 11 (11%) pts. Median KPS was 90% range 40-100%, PWB median 23 (range 6-28), and MSAS SF median PHYS 0.76 (range 0-3.2). Overall median survival was 285 days (range 6-2,358) and 80 pts (82%) had died. There was 1 pt in group 1, 58 in group 2, 12 in group 3, and 23 in group 4. The patient in group 1 had uterine sarcoma. Median survival (days) by RPA group was 155 for group 1, 177 for group 2, 292 for group 3, and 674 for group 4 (p=.011). Conclusions: These preliminary findings suggest that this algorithm is capable of dividing patients with metastatic solid tumor who are starting systemic therapy into prognostic groups. Further development is indicated.

P0110 Changes in quality of life and symptom experience in breast cancer patients with adjuvant treatment

Background Women diagnosed with breast cancer face significant side-effects such as nausea, vomiting, hair loss, and cognitive impairment and emotional distress due to aggressive adjuvant treatment. These side-effects adversely affect quality of life and symptom experience. The purpose of the study was to describe how quality of life and symptom experience develops over time in breast cancer patients undergoing adjuvant chemotherapy and radiotherapy. Methods The study group was 113 women who had surgery and scheduled for adjuvant chemotherapy ( n = 71) or radiotherapy ( n = 42). Patients were assessed with quality of life (Functional Assessment of Cancer Therapy for Breast Cancer) and symptom experience (Memorial Symptom Assessment Scale-Short Form) before chemotherapy or radiotherapy (pretest), after chemotherapy or radiotherapy (post-test), and 6 months after chemotherapy or radiotherapy (follow-up test). Analysis of variance of repeated measures was used to investigate the change in quality of life and symptom experience in two groups. Findings Patients receiving chemotherapy showed a significant increase in overall symptoms and physical symptoms between baseline and post-test. Overall quality of life, physical well-being, emotional well-being, and breast cancer specific domain decreased from pretest to post-test in the chemotherapy group but increased from post-test to the follow-up test. By contrast, there were no significant changes in symptom experience for the patients receiving radiotherapy. Significant increases were seen in overall quality of life, physical well-being, emotional well-being and breast cancer specific domain from baseline to follow-up test in patients receiving radiotherapy. Interpretation When considering the substantial increase in life expectancy in persons with breast cancer, nursing practice and research should focus on quality of life and provide interventions to improve symptom experience and quality of life.

Psychometric Assessment of the MSAS-SF and the FACIT-Fatigue Scale in Spanish-Speaking Patients With Cancer in Uruguay

ContextSeveral instruments have been developed to assess the symptom burden and fatigue produced by cancer and its treatment. However, little research has been conducted in Latin American Spanish–speaking patients. ObjectivesThe aim of the study was to assess the psychometric properties of the Spanish versions of two commonly used patient-reported outcome measures, the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), and the fatigue subscale of the Functional Assessment of Cancer Therapy-General (FACT-G), the FACIT-Fatigue. MethodsA classic psychometric approach was followed to assess the reliability and validity of the instruments. Responsiveness to change and effect sizes were calculated. ResultsThe translated version of the MSAS-SF proved to be comprehensible and easy to complete. Cronbach alpha reliability coefficients ranged from acceptable to excellent for the MSAS-SF subscale scores and the FACIT-Fatigue. There was evidence of convergent validity between the physical and the psychological subscales of the instruments. The MSAS-SF could discriminate among the known groups according to Eastern Cooperative Oncology performance status and level of anemia, and showed responsiveness to change of symptom burden at two times of treatment. ConclusionThe study showed that both the MSAS-SF and the FACIT-Fatigue have good reliability and validity for use with patients with cancer in Uruguay. When used simultaneously, these instruments may provide a complete picture of the impact of cancer and its treatment on the patient's quality of life.

Patient-reported outcomes for determining prognostic groups in veterans with stage IV solid tumors starting systemic therapy.

9567 Background: A Recursive Partitioning Analysis (RPA) algorithm predicted four groups with distinct median survivals in patients with advanced cancer entering palliative care (ASCO 2010, Abst 9040). We investigated whether this algorithm could apply to cancer patients starting systemic therapy. Methods: The RPA algorithm is based upon Karnofsky performance status (KPS), Functional Assessment of Cancer Therapy (FACT) physical well-being (PWB) subscale, and Memorial Symptom Assessment Scale Short Form (MSAS-SF) physical symptom distress (PHYS) subscale. Starting in 2007, a convenience sample of Veterans who were prescribed systemic treatment for their cancer was enrolled in an IRB approved protocol, and completed quality of life (FACT- G) and symptom (MSAS SF) questionnaires prior to starting the first cycle of treatment. We analyzed records of patients with stage IV metastatic solid tumors enrolled through August 2011, and determined survival as of December 1, 2012. Analyses were performed with STATA 11.0. Results: There were 72 patients (pts). The median age was 63 yrs, (range 46-86). Men comprised 71 (98%) pts. First line systemic therapy was given to 59 (82%) pts. The most common primary sites were lung cancer (25 pts, 35%), prostate 9 pts(12%) and colon 7 pts (10%). Median KPS was 90% (range 40-100%), PWB median 23 (range 6-28), and MSAS SF median PHYS 0.73 (range 0-2.93). Overall median survival was 269 days (range 6-1762) and 57 pts (79%) had died. There was 1 pt in group 1, 45 pts in group 2, 8 pts in group 3, and 18 pts in group 4. Median survival (days) by RPA group was 155 for group 1, 177 for group 2, 292 for group 3, and 610 for group 4 (p=.011). Conclusions: These preliminary findings suggest that this algorithm is capable of dividing patients with metastatic solid tumor who are starting chemotherapy into prognostic groups. It may have applications in clinical trials. Further development is indicated. [Table: see text]

Screening Instruments for Depression in Advanced Cancer Patients: What Do We Actually Measure?

Patients in a palliative care trajectory frequently suffer from depression. To distinguish depression from normal sadness, the use of screening instruments could facilitate the diagnostic process. However, in palliative care, screening instruments may not discern physical symptom burden from psychological distress, due to the high number of physical symptoms in palliative patients. The aim of this study was to explore physical symptom burden and psychological distress in patients with advanced cancer in relation to scores on screening instruments for depression. Patients with advanced cancer were asked to fill out the Beck Depression Inventory (BDI-II), Beck Depression Inventory Primary Care (BDI-PC), Hospital Anxiety and Depression Scale (HADS), and Memorial Symptom Assessment Scale Short Form (MSAS-SF). The relationship between scores on screening tools for depression and different physical symptom clusters was explored. In the sample of 65 patients, screening instruments for depression correlated highly with different somatic symptom clusters. The BDI-II cognitive subscale was the only scale that was not significantly correlated with any of the somatic symptom clusters. Screening tools for the detection of depression in patients with advanced cancer may not provide an accurate evaluation of depression. These tools seem to measure physical symptom burden as well, especially when patients suffer from symptoms of the clusters fatigue/anorexia/cachexia, neuropsychology, debility, or pain. In this study, the BDI-II cognitive subscale seems to differentiate best from somatic symptom burden.

Item Response Modeling of Presence-Severity Items

The Presence-Severity (P-S) format refers to a compound item structure in which a question is first asked to check the presence of the particular event in question. If the respondent provides an affirmative answer, a follow-up is administered, often about the frequency, density, severity, or impact of the event. Despite the popularity of the P-S format in areas such as patient reported outcomes, little attention has been paid to their psychometric analysis, which is necessary for making key design decisions about a scale. In this study, an item response theory–based framework is proposed to perform item analysis involving P-S data, which improves psychometric analysis for (a) scoring response categories, (b) calibrating items, (c) calculating reliability or internal consistency, and (d) selecting and revising items. A real-data example involving the Memorial Symptom Assessment Scale–Short Form, which is used as symptom distress measure for terminally ill cancer patients, demonstrates how the new framework can be used to address various psychometric issues in practice.

Prevalence, Burden, and Correlates of Physical and Psychological Symptoms Among HIV Palliative Care Patients in Sub-Saharan Africa: An International Multicenter Study

ContextDespite HIV remaining life limiting and incurable, very little clinical research focus has been given to the prevalence and related burden of physical and psychological symptoms for those accessing palliative care. Despite evidence of problems persisting throughout the trajectory and alongside treatment, scant attention has been paid to these manageable problems. ObjectivesThis study aimed to measure the seven-day period prevalence and correlates of physical and psychological symptoms, and their associated burden, in HIV-infected individuals attending palliative care centers in sub-Saharan Africa. MethodsConsecutive patients in five care centers across two countries completed the Memorial Symptom Assessment Scale-Short Form, with additional demographic and disease-oriented variables. ResultsTwo hundred twenty-four patients participated. The most common symptoms were pain in the physical dimension (82.6%) and worry in the psychological dimension (75.4%). Interestingly, 71.4% reported hunger. Women, and those with worse physical function, were more likely to experience burden. However, being on antiretroviral therapy (ART) was not associated with global, physical, or psychological symptom burden. ConclusionThis study is the first to report physical and psychological symptom burden in HIV-infected populations receiving palliative care in sub-Saharan Africa. Despite increasing access to ART, these burdensome and manageable problems persist. The assessment of these problems is essential alongside assessment of ART virological outcomes.