Assessing symptom distress in cancer patients. The M.D. Anderson symptom inventory. (The University of Texas M. D. Anderson Cancer Center, Houston, Texas) Cancer 2000;89:1634–1646.

Abstract

The purpose of this project was to develop the M. D. Anderson Symptom Inventory (MDASI), a brief measure of the severity and impact of cancer‐related symptoms. A list of symptoms was generated from symptom inventories and by panels of clinicians. Twenty‐six symptoms and 6 interference items were rated by a validation sample of 527 outpatients, a sample of 30 inpatients from the blood and bone marrow transplantation service, and a cross‐validation sample of 113 outpatients. Clinical judgement and statistical techniques were used to reduce the number of symptoms. Reliability, validity, and sensitivity of the MDASI were examined. Cluster analysis, best subset analysis, and clinical judgement reduced the number of symptoms to a “core” list of 13 that accounted for 64% of the variance in symptom distress. Factor analysis demonstrated a similar pattern in both outpatient samples, and two symptom factors and the interference scale were reliable. Expected differences in symptom pattern and severity were found between patients with “good” versus “poor” performance status and between patients in active therapy and patients who were seen for follow‐up. Patients rated fatigue‐related symptoms as the most severe. Groups of patients classified by disease or treatment had severe symptoms that were not on the “core” list. Conclude the core items of the MDASI accounted for the majority of symptom distress reported by cancer patients in active treatment and those who were followed after treatment. The MDASI should prove useful for symptom surveys, clinical trials, and patient monitoring, and its format should allow Internet or telephone administration.

Evaluation of the Symptom Representation Questionnaire (SRQ) for Assessing Cancer-Related Symptoms

“…The symptom list was modified for the SRQ based on recommendations from the developers of the original IPQ that the core symptom list be amended to reflect the symptoms common to the type of illness being studied. The SRQ symptom list was originally generated from the M. D. Anderson Symptom Inventory (MDASI) that includes 13 symptoms common to individuals receiving treatment for cancer (2). This list was then reviewed by four gynecologic oncologists, two oncology certified nurses with expertise in gynecologic oncology, and two doctorallyprepared experts in symptom assessment.…”

“…Identity on the SRQ is then operationalized as the severity of the particular symptom being assessed. The 0-10 numerical rating scale is the most widely used scale for assessing symptom severity and has well-established psychometric properties in pain, fatigue, and multi-symptom assessment (2,38,39).…”

“…This subscale assesses the extent to which symptoms have interfered with life activities during the past week and was used as a measure of convergent construct validity (2). Specific items of the MDASI include ratings of interference with general activity, mood, work, relations with other people, walking, and enjoyment of life.…”

“…The importance of a multi-dimensional, multi-symptom approach to symptom assessment and management has recently been emphasized across health care disciplines (1)(2)(3)(4)(5). However, which dimensions are most critical to assess remains unclear (6).…”

“…For those that do assess multiple dimensions of multiple symptoms (>5), the majority focus on the presence of symptoms in combination with measures of symptom severity and/or distress (9)(10)(11)(12)(13)(14)(15)(16). Two instruments add an assessment of frequency or duration (17,18) while two others add an assessment of interference with function or life activities to the assessment of presence and severity (2,19). Finally, one tool weights the importance of symptoms independently from measures of intensity and distress (20).…”