Use of a Single-Item Screening Tool to Detect Clinically Significant Fatigue, Pain, Distress, and Anorexia in Ambulatory Cancer Practice

Abstract

Fatigue, pain, distress, and anorexia are four commonly encountered symptoms in cancer. To evaluate the usefulness of a single-item screening for these symptoms, 597 ambulatory outpatients with solid tumors were administered a self-report screening instrument within the first 12 weeks of chemotherapy. Patients rated the severity of each symptom on a 0-10 scale, at its worst over the past three days, with higher ratings associated with higher symptom levels. From this sample, 148 patients also completed a more comprehensive assessment of these symptoms. Two criteria were used to determine optimal cut-off scores on the screening items: 1) the sensitivity and specificity of each screening item to predict clinical cases using receiver-operating characteristics analysis and 2) the proportion of patients at each screening score who reported that some relief of the target symptom would significantly improve their life. Optimal cut-off scores ranged from 4 to 6 depending on the target symptom (area under the curve range=0.68-0.88). Use of single-item screening instruments for fatigue, pain, distress, and anorexia may assist routine clinical assessment in ambulatory oncology practice. In turn, such assessments may improve identification of those at risk of morbidity and decreased quality of life due to excess symptom burden.

Chemotherapy-Related Cognitive Impairment: The Breast Cancer Experience

“…Patient burden should be a consideration in determining the extent of testing that occurs in each session. An additional challenge exists for patients experiencing the fatigue associated with a cancer diagnosis and treatment (Butt et al, 2008). Several hours of testing may not be practical.…”

Salud mental y malestar emocional en pacientes con cáncer

“…También este tipo de escalas de síntomas emocionales y físicos siguen la tendencia actual a una mayor brevedad, para ajustarse a la realidad asistencial, como ocurre en la desarrollada por Zeeshan Butt y colaboradores, en USA (118) en pacientes ambulatorios con cáncer, de sólo 4 ítems: 1 Fatiga, 2 Dolor, 3 Malestar emocional, y 4 Anorexia; y en otras más sencillas, como la escala visual analógica (EVA) desarrollada en nuestro medio por el grupo ASTHENOS (119) . Estos instrumentos breves de evaluación destacados no están exentos de dificultades, debidas al tipo de formato, a las mediciones usadas, al tiempo requerido para administrarlos, y a la dificultad de los médicos para su interpretación.…”

Characterizing Distress, the 6th Vital Sign, in an Oncology Pain Clinic

“…A cut-off of 4 or more out of 10 has been recommended for use as a screening tool for pain within ambulatory cancer patients 21 , and a cut-off of 7 or more was used to identify severe levels of pain.…”

“…Few studies have examined single-item screening tools for fatigue. One study reported a cut-off of 3 as optimal 22 ; another reported a cut-off of 5 21 . The U.S. National Comprehensive Cancer Network recommends using a cut-off of 4 or more to identify cases of possible fatigue.…”