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Cancer symptom scale preferences: does one size fit all?
  1. Kirby Jeter1,
  2. Siobhan Blackwell1,
  3. Lucy Burke1,
  4. David Joyce1,2,
  5. Catherine Moran1,
  6. Emma Victoria Conway1,
  7. Iseult Cremen1,
  8. Brenda O'Connor1,2,
  9. Pauline Ui Dhuibhir1 and
  10. Declan Walsh1,2,3
  1. 1Education and Research Centre, Our Lady's Hospice, Dublin, Ireland
  2. 2UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
  3. 3School of Medicine, Trinity College Dublin, College Green, Dublin, Ireland
  1. Correspondence to Professor Declan Walsh, Faculty of Health Sciences, Trinity College Dublin 2, Ireland; walshtd{at}tcd.ie

Abstract

Objectives Patients with advanced cancer do not report all symptoms, so assessment is best done systematically. However, for such patients, completion rates of some symptom instruments are <50%. Symptoms can be quantified by various scales including the Categorical Response Scale (CRS), Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Patient preferences for CRS, NRS and VAS in symptom assessment and their clinical utility in 3 cancer symptoms: pain, tiredness and appetite loss were determined.

Methods A prospective survey was conducted involving cancer admissions to a 36-bed palliative care unit.

Results 100 inpatients were recruited, aged 38–93 years (x̅ =71 years; SD=11.6), with median Eastern Cooperative Oncology Group (ECOG) scores of 2 (range 0–4). VAS was the least preferred measure. 52% of patients choose the same scale for all 3 symptoms and 44% for 2, with 4% choosing a different individual scale per symptom. There was moderate agreement between participant scale preference and observer determined ease of scale completion (loss of appetite: κ=0.36; pain: κ=0.49; tiredness: κ=0.45). Participants preferred CRS for appetite loss (48%) and tiredness (40%) and NRS for pain (44%).

Conclusions VAS was the least favoured scale and should be used cautiously in this population. Most participants had a scale preference with high intrapatient consistency between scales. CRS was preferred for appetite loss and tiredness and NRS for pain. Consideration should be given to individualised cancer symptom assessment according to patient scale preference.

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  • Received 17 September 2015.
  • Revision received 3 June 2016.
  • Accepted 14 July 2016.
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