Assessing symptom distress in cancer patients - The M. D. Anderson SymptomInventory

BACKGROUND. The purpose of this project was to develop the M. D. Anderson S ymptom Inventory (MDASI), a brief measure of the severity and impact of can cer-related symptoms. METHODS. A list of symptoms was generated from symptom inventories and by p anels of clinicians. Twenty-six symptoms and 6 interference items were rate d 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 judgment and statistical techniques wer e used to reduce the number of symptoms. Reliability, validity, and sensiti vity of the MDASI were examined. RESULTS. Cluster analysis, best subset analysis, and clinical judgment redu ced 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 p attern in both outpatient samples, and two symptom factors and the interfer ence scale were reliable. Expected differences in symptom pattern and sever ity were found between patients with "good" versus "poor" performance statu s and between patients in active therapy and patients who were seen for fol low-up. Patients rated fatigue-related symptoms as the most severe. Groups of patients classified by disease or treatment had severe symptoms that wer e not on the "core" list. CONCLUSIONS. The core items of the MDASI accounted for the majority of symp tom distress reported by cancer patients in active treatment and those who were followed after treatment. The MDASI should prove useful for symptom su rveys, clinical trials, and patient monitoring, and its format should allow Internet or telephone administration. Cancer 2000;89:1634-46. (C) 2000 Ame rican Cancer Society.