Study Identifies Symptom Assessment Cut-Points to Guide Cancer Symptom Interventions

A new study published in the Journal of Pain and Symptom Management uncovered clinically meaningful cut-points for oncology patients’ symptoms, helping alert clinicians to when symptom interventions are needed. The researchers categorized 38 symptoms from the Memorial Symptom Assessment Scale (MSAS) into low, moderate, and high symptom burden categories. The research team, led by symptom science expert Dr. Christine Miaskowski, RN, PhD of the University of California San Francisco, suggest that clinicians use this tool as a screening instrument and intervene to support patients with high symptom burden.

The goal of the study was to determine the most appropriate cut-points for symptom burden and determine if these cut-points were able to distinguish between each symptom burden groups’ demographic, clinical, stress, and quality of life characteristics.

The researchers analyzed data from N=1,329 adult patients who were actively receiving outpatient chemotherapy for a variety of solid tumors. Recruitment occurred at a variety of academic, community, and Veteran’s Affairs hospitals.

A modified version of the MSAS was selected to analyze because it is one of the most commonly used symptom assessments in cancer care and evaluates the occurrence, severity, frequency, and distress associated with 38 symptoms commonly associated with cancer and treatment. Patients completed several additional measures to assist with developing the cut-points, including the Quality of Life-Patient Version.

The authors compared various potential cut-points to determine which best distinguished between patients’ symptom reports and quality of life scores. They also compared the symptom groups based on related patient-reported outcome measures and patients’ demographic and clinical information.

The results identified low (0 to 8), moderate (9 to 15), and high (16 to 38) symptom burden categories; 38.4% of patients reported symptoms that placed them in the “high” group. As expected, the quality-of-life scores corresponded to the cut-points with the low symptom burden group reporting the highest quality of scores and the high symptom burden group reporting the lowest. Other measures also helped differentiate the symptom burden groups and verify the cut-points.

This study is especially relevant to oncology nurses because the cut-points were created using clinically relevant metrics like quality of life and stress, demonstrating that patients who score in the “moderate” and “high” groups had progressively worse outcomes than the “low” group.

As symptom assessment and monitoring becomes more routine practice in oncology care, oncology nurses can use these results to create thresholds for intervention. The authors note that other studies have shown that symptom monitoring is known to improve adherence to treatment, increase patients’ quality of life, and overall survival. They conclude that this study “can be used to alert clinicians to patients who warrant time sensitive interventions.”

Dr. Teresa Hagan Thomas is a nurse and researcher. She is passionate about improving cancer care to ensure patients’ needs and priorities drive the care they receive. Dr. Thomas has an active program of research integrating patient self-advocacy, symptom management, serious games for health, and palliative care. She also teaches at the undergraduate and graduate level and serves as mentor to nursing students and researchers. She lives in Pittsburgh, PA, with her husband and two boys.