Paper| Volume 30, ISSUE 9, P1326-1336, 1994

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The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress

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      The Memorial Syptom Assessment Scale (MSAS) is a new patient-rated instrument that was developed to provide multidimensional information about a diverse group of common symptoms. This study evaluated the reliability and validity of the MSAS in the cancer population. Randomly selected inpatients and outpatients (n = 246) with prostate, colon, breast or ovarian cancer were assessed using the MSAS and a battery of measures that independently evaluate phenomena related to quality of life. Symptom prevalence in the 218 evaluable patients ranged from 73.9% for lack of energy to 10.6% for difficulty swallowing. Based on a content analysis, three symptoms were deleted and two were added; the revised scale evaluates 32 physical and psychological symptoms. A factor analysis of variance yielded two factors that distinguished three major symptom groups and several subgroups. The major groups comprised psychological symptoms (PSYCH), high prevalence physical symptoms (PHYS H), and low prevalence physical symptoms (PHYS L). Internal consistency was high in the PHYS H and PSYCH groups (Cronback α coefficients of 0.88 and 0.83, respectively), and moderate in the PHYS L group (α = 0.58). Although the severity, frequency and distress dimensions were highly intercorrelated, canonical correlations and other analyses demonstrated that multidimensional assessment (frequency and distress) augments information about the impact of symptoms. High correlations with clinical status and quality of life measures support the validity of the MSAS and indicate the utility of several subscale scores, including PSYCH, PHYS, and a brief Global Distress Index. The MSAS is a reliable and valid instrument for the assessment of symptom prevalence, characteristics and distress. It provides a method for comprehensive symptom assessment that may be useful when information about symptoms is desirable, such as clinical trials that incorporate quality of life measures or studies of symptom epidemiology.


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        • Curtis EB
        • Kretch R
        • Walsh TD
        Common symptoms in patients with advanced cancer.
        J Palliat Care. 1991; 7: 25-29
        • Dunphy KP
        • Amesbury BDW
        A comparison of hospice and homecare patients: patterns of referral, patient characteristics and predictors of place of death.
        Palliat Med. 1990; 4: 105-111
        • Dunlop GM
        A study of the relative frequency and importance of gastrointestinal symptoms and weakness in patients with far-advanced cancer: student paper.
        Palliat Med. 1989; 4: 37-43
        • Reuben DB
        • Mor V
        • Hiris J
        Clinical symptoms and length of survival in patients with terminal cancer.
        Arch Intern Med. 1988; 148: 1586-1591
        • Derogatis LR
        • Morrow GR
        • Fetting J
        • et al.
        The prevalence of psychiatric disorders among cancer patients.
        J Am Med Assoc. 1983; 249: 751-757
        • Craig TJ
        • Abeloff MD
        Psychiatric symptomatology among hospitalized cancer patients.
        Am J Psych. 1974; 131: 1323-1336
        • Levine PM
        • Silberfarb PM
        • Lipowski ZJ
        Mental disorders in cancer patients: a study of 100 psychiatric referrals.
        Cancer. 1978; 42: 1386-1391
        • Massie MJ
        • Holland JC
        Overview of normal reactions and prevalence of psychiatric disorders.
        in: Holland JC Rowland JH Handbook of Psychooncology. Oxford University Press, New York1989: 273-282
        • Cella DF
        • Tulsky DS
        Measuring quality of life today: methodological aspects.
        Oncology. 1990; 4: 29-38
        • Moinpour CM
        • Feigl P
        • Metch B
        • Hayden KA
        • Meyskens FL
        • Crowley J
        Quality of life end points in cancer clinical trials: review and recommendations.
        J Natl Cancer Inst. 1989; 81: 485-495
        • Aaronson NK
        • Bakker W
        • Stewart A
        • et al.
        Multidimensional approach to the measurement of quality of life in lung cancer clinical trials.
        in: Aaronson NK Beckmann JH The Quality of Life of Cancer Patients. Raven Press, New York1987: 63-82
        • Donovan K
        • Sanson-Fisher RW
        • Redman S
        Measuring quality of life in cancer patients.
        J Clin Oncol. 1989; 7: 959-968
        • Nayfield SG
        • Ganz PA
        • Moinpour CM
        • et al.
        Report from a National Cancer Institute (USA) workshop on quality of life assessment in cancer clinical trials.
        Qual Life Res. 1992; 1: 203-210
        • Calman KC
        Definitions and dimensions of quality of life.
        in: Aaronson NK Beckman JH The Quality of Life of Cancer Patients. Raven Press, New York1987: 1-9
        • Aaronson NK
        • Ahmedzai S
        • Bergman B
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology.
        J Natl Cancer Inst. 1993; 85: 365-376
        • Schipper H
        • Clinch J
        • McMurray A
        • Levitt M
        Measuring the quality of life of cancer patients: the functional living index-cancer. Development and validation.
        J Clin Oncol. 1984; 2: 472-483
        • Ganz PA
        • Schag CAC
        • Lee JJ
        • et al.
        The CARES: a generic measure of health-related quality of life for patients with cancer.
        Qual Life Res. 1992; 1: 19-29
        • Cella DF
        • Tulsky DS
        • Gray G
        • et al.
        The functional assessment of cancer therapy scale: development and validation of the general measure.
        J Clin Oncol. 1993; 11: 570-579
        • Cella DF
        • Jacobsen PB
        • Lesko LM
        Research methods in psychooncology.
        in: Holland JC Rowland JH Handbook of Psychooncology. Oxford University Press, New York1989: 737-749
        • Stewart AL
        • Hays RD
        • Ware JE
        The MOS short-form general health survey: reliability and validity in a patient population.
        Med Care. 1988; 26: 724-735
        • Hunt SM
        • McKenna SP
        • McEwen J
        • Williams J
        • Papp E
        The Nottingham health profile: subjective health status and medical consultations.
        Soc Sci Med. 1981; 15A: 221-229
        • Chambers LW
        • MacDonald LA
        • Tugwell R
        • Buchanan WW
        • Kraag G
        The McMaster Health Index Questionnaire as a measure of quality of life for patients with rheumatoid disease.
        J Rheumatol. 1982; 7: 780-784
        • McCorkle R
        • Young K
        Development of a symptom distress scale.
        Cancer Nurs. 1978; 1: 373-378
        • Kukull WA
        • McCorkle R
        • Driever M
        Symptom distress, psychosocial variables and survival from lung cancer.
        J Psychosoc Oncol. 1986; 4: 91-104
        • Welch JM
        • Barlow D
        • Richardson PH
        Symptoms of HIV disease.
        Palliat Med. 1991; 5: 46-51
        • de Haes JCJM
        • van Knippenberg FCE
        • Neijt JP
        Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist.
        Br J Cancer. 1990; 62: 1034-1038
        • de Haes JCJM
        • Raatgever JW
        • van der Burg MEL
        • Hamersma E
        • Neijt JP
        Evaluation of the quality of life of patients with advanced ovarian cancer treated with combination chemotherapy.
        in: Aaronson NK Beckman J The Quality of Life of Cancer Patients. Raven Press, New York1987: 217-225
        • Hopwood P
        • Howell A
        • Maguire P
        Psychiatric morbidity in patients with advanced cancer of the breast: prevalence measured by two self-rating questionnaires.
        Br J Cancer. 1991; 64: 349-352
        • Fishman B
        • Pasternak S
        • Wallenstein S
        • Houde R
        • Holland JC
        • Foley KM
        The Memorial Pain Assessment Card: a valid instrument for the assessment of cancer pain.
        Cancer. 1987; 60: 1151-1157
        • Brook RH
        • Ware JE
        • Davies-Avery A
        • et al.
        Conceptualization and measurement of health for adults.
        in: 2nd ed. The Health Insurance Study. Vol. VIII. 1979 (Overview. Santa Minoca, Rand)
        • Ware JE
        • Johnston SA
        • Davies-Avery A
        • et al.
        Conceptualization and measurement of health for adults.
        in: The Health Insurance Study. 2nd ed. Vol. III: Mental Health. 1979 (Santa Monical, Rand)
        • Veit CT
        • Ware JE
        The structure of psychological distress and well-being in general populations.
        J Consult Clin Psych. 1983; 51: 730-742
        • Kornblith AB
        • Hollis D
        • Zuckerman E
        • et al.
        Effect of megestrol acetate upon quality of life in a dose-response trial in women with advanced breast cancer patients.
        J Clin Oncol. 1993; 11: 2081-2089
        • Yates JW
        • Chalmer B
        • McKegney FP
        Evaluation of patients with advanced cancer using the Karnofsky Performance Status.
        Cancer. 1980; 40: 2222-2224
        • Yochmowitz MG
        Factor analysis-of-variance model (FANOVA).
        in: 2nd ed. Encyclopedia of Statistical Sciences. Vol. 3. Wiley, New York1986: 9-13
        • Nunnally JC
        Psychometric Theory.
        2nd ed. McGraw Hill, New York1978
        • Campbell DT
        • Fiske DW
        Convergent and discriminant validation by the multitrait-multimethod matrix.
        Psychol Bull. 1959; 56: 81-105
        • Morrow GR
        • Lindke J
        • Black P
        Measurement of quality of life in patients: psychometric analyses of the Functional Living Index-Cancer (FLIC).
        Qual Life Res. 1992; 1: 287-296
        • Sadura A
        • Pater J
        • Osoba D
        • Levine M
        • Palmer M
        • Bennet K
        Quality of life assessment: patient compliance with questionnaire completion.
        J Natl Cancer Inst. 1992; 84: 1023-1026
        • Peruselli C
        • Camporesi E
        • Colombo AM
        • Cuicci M
        • Mazzoni G
        • Paci E
        Qualify of life assessment in a home care program for advanced cancer patients: a study using the Symptom Distress Scale.
        J Pain Symptom Manage. 1993; 8: 306-311