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Assessing Symptoms Experienced by Patients With Cancer

Occurrence, Intensity, Distress, Interference, and Frequency

McMillan, Susan C. PhD, ARNP, FAAN; Tofthagen, Cindy PhD, ARNP, AOCNP; Choe, Robyn MS, RN; Rheingans, Jennifer PhD, RN

Journal of Hospice & Palliative Nursing: February 2015 - Volume 17 - Issue 1 - p 56–65
doi: 10.1097/NJH.0000000000000123
Feature Articles

Patients with cancer experience multiple symptoms during their disease trajectory, all of which have the potential to cause significant distress and interference with patient quality of life. In order to adequately manage cancer-related symptoms, nurses caring for patients with cancer need to fully understand each patient’s symptom experience. The purpose of this study was to identify the symptom profile of patients being treated for cancer and to validate a new symptom assessment tool for use with persons with cancer. A sample of 234 sequential patients with a variety of cancers was accrued over 18 months in a community medical center and a regional cancer center. Consenting patients completed the newly developed Cancer Symptom Scale (CSS), the Multidimensional Quality of Life–Cancer scale, and a demographic data form. A subset of patients completed the CSS a second time with a short delay. Descriptive statistics were used to report the symptom data, and Pearson correlations and Cronbach’s α were used to evaluate the validity and reliability. The sample had slightly more women (55.6%) than men and was predominantly white (82.9%) and married (63.2%). The most common types of cancer reported were leukemia, breast, lymphoma, and colorectal cancer. The mean age of the sample was 60.4 years. Fatigue and feeling drowsy affected more than half of the sample. Feeling irritable (mean, 7.3), having problems with sex (mean, 6.6), and sweats (mean, 6.3) had the highest intensity mean scores, whereas feeling irritable (mean, 6.7) and diarrhea (mean, 6.4) caused the most distress. Most frequently occurring symptoms were problems with urination (mean, 6.9) and problems with sex (mean, 6.9). Symptoms causing the most interference with life were diarrhea (mean, 6.0) and feeling irritable (mean, 5.7). Correlation of CSS subscales with the Multidimensional Quality of Life–Cancer scale (r = −0.34 to −0.56; P = .000) at the hypothesized level supported construct validity. Test-retest reliability (r = 0.74-0.81) and internal consistency (α = .73-.74) were excellent. Patients have multiple symptoms that are intense, distressing, and frequent and cause interference with their lives, and all have an impact on the overall quality of their lives. Thus, nurses should use comprehensive and validated tools to assess these multiple symptoms in order to be able to manage them. The CSS is a valid and reliable tool that is useful in assessing multiple dimensions of multiple symptoms in patients with cancer. Further studies of its validity and reliability are warranted.

Susan C. McMillan, PhD, ARNP, FAAN, is distinguished university professor (Thompson Professor of Oncology Nursing), College of Nursing, University of South Florida, Tampa.

Cindy Tofthagen, PhD, ARNP, AOCNP, is assistant professor, College of Nursing, University of South Florida, Tampa.

Robyn Choe, MS, RN, is doctoral student, College of Nursing, University of South Florida, Tampa.

Jennifer Rheingans, PhD, RN, is clinical nurse researcher, Sarasota Memorial Hospital, Florida.

Address correspondence to Susan C. McMillan, PhD, ARNP, FAAN, MDC Box 22, 12901 Bruce B Downs Blvd, College of Nursing, University of South Florida, Tampa, FL 33612 (

The authors have no conflicts of interest to disclose.

© 2015 by The Hospice and Palliative Nurses Association.