The measurement of symptoms in children with cancer

The purpose of this study was to determine symptom prevalence, characterist ics, and distress in children with cancer. The Memorial Symptom Assessment Scale (MSAS) 10-18 a 30-item patient-rated instrument adapted from a previo usly validated adult version, provided multidimensional information about t he symptoms experienced by children with cancer This instrument was adminis tered to 160 children with cancer aged 10-15 (45 inpatients, 115 outpatient s). To confirm the instrument's reliability and validity, additional data a bout symptoms were collected from both the parents and the medical charts, and retesting was performed on a subgroup of inpatients. Patients could eas ily complete the scale in a mean of 11 minutes. The analyses supported the reliability and validity of the MSAS 10-18 subscale scores as measures of p hysical, psychological, and global symptom distress, respectively. Symptom prevalence ranged from 49.7% for lack of energy to 6.3% for problems with u rination. The mean (+/- SD) number of symptoms per inpatient was 12.7 +/- 4 .9 (range, 4-26), significantly more than the mean 6.5 +/- 5.7 (range, 0-28 ) symptoms per outpatient. Patients who had recently received chemotherapy had significantly more symptoms than patients who had not received chemothe rapy for. more than 4 months (11.6 +/- 6.0 vs. 5.2 +/- 5.1), and those pati ents with solid tumors had significantly more symptoms than patients with e ither leukemia, lymphoma, or central nervous system malignancies (9.9 +/- 7 .0 vs. 6.8 +/- 5.5 vs. 6.8 +/- 5.0 vs. 8.0 +/- 6.1). The most common sympto ms (prevalence > 35%) were lack of energy, pain, drowsiness, nausea, cough, lack of appetite, and psychological symptoms (feeling sad, feeling nervous , worrying feeling irritable). Of the symptoms with prevalence rates > 35%, those that caused high distress in more than one-third of patients were fe eling sad, pain, nausea, lack of appetite: and feeling irritable. Subscale scores demonstrated large variability in symptom distress and could identif y subgroups with high distress. The prevalence, characteristics, and distre ss associated with physical and psychological symptoms could be quantified in older children with cancer The data confirm a high prevalence of symptom s overall and the existence of subgroups with high distress associated with one or multiple symptoms. Symptom distress is relatively higher among inpa tients, children with solid tumors, and children who are undergoing antineo plastic treatment. Systematic symptom assessment may be useful in future ep idemiological studies of symptoms and in clinical chemotherapeutic trials. Symptoms epidemiology may also provide a focus for future clinical trials r elated to symptom management in children with cancer. (C) U.S. Cancer Pain Relief Committee, 2000.