COSMIN database

Cancer symptom assessment instruments: a systematic review

Kirkova, J., Davis, M. P., Walsh, D., Tiernan, E., O'Leary, N., LeGrand, S. B., Lagman, R. L., and Russell, K. M.
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.
J Clin Oncol
1527-7755 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Physical state
Overall quality of life:
Overall quality of life
Adults (18-65)
Seniors (65+)
Neoplasms and related symptoms
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
6 - Clinical rating scales
7 - Observations
ASDS-2 - Adapted Symptom Distress Scale-modified
CAMPAS-R - Cambridge Palliative Assessment Schedule
CAS - Constipation Assessment Scale
CMSAS - Condensed Memorial Symptom Assessment Scale
Computerized Symptom Assessment Instrument
C-SAS - Chemotherapy Symptom Assessment Scale
CSS - Canberra Symptom Score Card
Dyspnea Numerical Scale
ESAS - Edmonton Symptom Assessment System
HADS - Hospital Anxiety and Depression Scale   
INV - Rhodes Index of Nausea and Vomiting
MANE - Morrow Assessment of Nausea and Emesis
MDASI - MD Anderson Symptom Inventory
M-ESAS - Modified Edmonton Symptom Assessment System
Modified SDS-LASA - Modified Symptom Distress Scale Linear Analogue Self-Assessment
MSAS - Memorial Symptom Assessment Scale (modifications exist for family caregivers and for hospice staff)
MSAS-SF - Memorial Symptom Assessment Scale-Short Form
NRS - Numeric Rating Scale [alias: NPRS - Numeric Pain Rating Scale]   
Objective assessment instrument to measure Pain, Dyspnea and Restlessness
OTTAT - Oncology Treatment Toxicity Assessment Tool
POMS-B - Profile of Mood States – Brief
POMS - Profile of Mood States
PSAR - Pain and Symptom Assessment Record
Reduced E-STAS - Reduced Expanded Support Team Assessment Schedule
Revised POMS - Revised Profile of Moods States
RSCL-M - Modified version of Rotterdam Symptom Checklist   
RSCL - Rotterdam Symptom Checklist   
SDS - Symptom Distress Scale
SRQ - Symptom Representation/reporting Questionnaire
Symptom Experience Scale
Symptom Monitor   
TRSC-reduced OTTAT; Therapy-Related Symptom Checklist reduced Oncology Treatment Toxicity Assessment Tool
Worthing Chemotherapy Questionnaire