Assessment of symptom clusters in people with cancer

The control, and ideally prevention, of symptoms such as pain, depression, and fatigue is dependent on a comprehensive clinical assessment. Furthermore, to advance the science of this field, symptom research requires the use of multidimensional instruments with proven validity and reliability in a cancer population across the lifespan. Studies demonstrate a significant correlation among pain, depression, fatigue, and other symptoms commonly seen throughout the course of cancer. Therefore, multidimensional scales incorporating the most common symptoms would ensure systematic assessment. Optimally, valid and reliable tools that measure symptom clusters would be feasible for use in both clinical and research settings. Currently available instruments that measure symptom clusters include the Edmonton Symptom Assessment Scale, the M.D. Anderson Symptom Inventory, the Memorial Symptom Assessment Scale, the Rotterdam Symptom Checklist, the Symptom Distress Scale, and others. Special populations include cancer patients with advanced disease, where symptom prevalence is expected to increase. Newer tools that attempt to address these populations are the Brief Hospice Inventory and the Hospice Quality of Life Index, appropriate for cancer patients with more advanced disease. Each of these tools has demonstrated utility in measuring symptom severity and quality of life. Few scales have been validated in the measurement of symptom clusters in children, in cognitively impaired adults, or in non-English speaking patients from various cultural backgrounds. The strengths and limitations presented in the clinical and research uses of each these instruments will be presented, as will be areas for future investigation.