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Cancer Symptom Assessment Instruments: A Systematic Review

Jordanka Kirkova, Mellar P. Davis, Declan Walsh, Eoin Tiernan, Norma O'Leary, Susan B. LeGrand, Ruth L. Lagman, K. Mitchell Russell

From the Harry R. Horvitz Center for Palliative Medicine, the Cleveland Clinic Foundation, Cleveland, OH; and the St Vincent's University Hospital, Dublin, Ireland

Address reprint requests to Declan Walsh, MSc, Cleveland Clinic Foundation, 9500 Euclid Ave, M76, Cleveland OH 44195; e-mail: walsht{at}ccf.org

PURPOSE: A variety of assessment instruments have been created to identify cancer symptoms. We reviewed systematically cancer symptom assessment instruments published in English.

METHODS: A systematic search of the MEDLINE database, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and EMBASE was performed. Non–peer-reviewed articles were identified through BIOSIS. Articles were accessed through the related article links in PubMed and references were searched by hand. Studies were included if the instrument had symptom assessment as the primary outcome. Quality-of-life instruments were excluded.

RESULTS: We identified 21 instruments; some had undergone modification or validation. An additional 28 studies examined symptom prevalence and interrelations; many involved symptom checklists. Studies varied in design, patient characteristics, symptoms, and outcome. Meta-analysis was not possible due to heterogeneity in design, study outcomes, and validation. Seventy-six articles and two conference abstracts (derived from MEDLINE, Cochrane, CINAHL, EMBASE, BIOSIS, related articles link in PubMed, and search by hand) met inclusion/exclusion criteria. The electronic search (without related links) yielded only 26% of those articles and conference abstracts that met inclusion criteria. Searches by hand of related articles identified 59% of studies.

CONCLUSION: Twenty-one instruments were identified as appropriate for clinical use. The instruments vary in symptom content and extent of psychometric validation. Both comprehensive and shorter instruments have been developed, and some instruments are intended for specific symptom assessment or symptoms related to treatment. There is no ideal instrument, and the wide variety of instruments reflects the different settings for symptom assessment. Additional research is necessary.

Supported by a Mount Sinai Health Care Foundation Research Fellowship in End of Life Care (J.K.).

Presented at the 17th Annual Symposium of the Multinational Association of Supportive Care in Cancer, June 30- July 2, 2005, Geneva, Switzerland.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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