COSMIN database

The psychometric properties of cancer multisymptom assessment instruments: a clinical review

Aktas, A., Walsh, D., and Kirkova, J.
PURPOSE: Various instruments are used to assess both individual and multiple cancer symptoms. We evaluated the psychometric properties of cancer multisymptom assessment instruments.

METHODS: An Ovid MEDLINE search was done. All searches were limited to adults and in English. All instruments published from 2005 to 2014 (and with at least one validity test) were included. We excluded those who only reported content validity. Instruments were categorized by the three major types of symptom measurement scales employed as follows: visual analogue (VAS), verbal rating (VRS), and numerical rating (NRS) scales. They were then examined in two areas: (1) psychometric thoroughness (number of tests) and (2) psychometric strength of evidence (validity, reliability, generalizability). We also assigned an empirical global psychometric quality score (which combined the concepts of thoroughness and strength of evidence) to rank the instruments.

RESULTS: We analyzed 57 instruments (17 original, 40 modifications). They varied in types of scales used, symptom dimensions measured, and time frames evaluated. Of the 57, 10 used VAS, 28 VRS, and 19 NRS. The Edmonton Symptom Assessment System (ESAS), ESAS-Spanish, Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Symptom Distress Scale (SDS), M.D. Anderson Symptom Inventory (MDASI)-Russian, and MDASI-Taiwanese were the most comprehensively tested for validity and reliability. The ESAS, ESAS-Spanish, ASDS-2, Memorial Symptom Assessment Scale (MSAS)-SF, POMS, SDS, MDASI (and some translations), and MDASI-Heart Failure all showed good validity and reliability.

CONCLUSIONS: The MDASI appeared to be the best overall from a psychometric perspective. This was followed by the ESAS, ESAS-Spanish, POMS, SDS, and some MDASI translations. VRS-based instruments were most common. There was a wide range of psychometric rigor in validation. Consequently, meta-analysis was not possible. Most cancer multisymptom assessment instruments need further extensive validation to establish the excellent reliability and validity required for clinical utility and meaningful research.
Support Care Cancer
1433-7339 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Physical state
Functional status:
Physical functioning
Role functioning
General health perceptions / HRQoL:
Self-rated health
Overall quality of life:
Overall quality of life
Adults (18-65)
Neoplasms and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
ASDS-2 - Adapted Symptom Distress Scale-modified
ASDS - Adapted Symptom Distress Scale
CAMPAS-R - Cambridge Palliative Assessment Schedule
CMSAS - Condensed Memorial Symptom Assessment Scale
Computerized questionnaire to be used in radiation oncology
C-SAS - Chemotherapy Symptom Assessment Scale
CSS - Canberra Symptom Score Card
ESAS - Edmonton Symptom Assessment System
GSDS - General Symptom Distress Scale
HADS - Hospital Anxiety and Depression Scale   
INV - Rhodes Index of Nausea and Vomiting
INVR - Index of Nausea, Vomiting, and Retching
MANE - Morrow Assessment of Nausea and Emesis
MDASI‐BT - MD Anderson Symptom Inventory-Brain Tumor Module
MDASI-HF - MD Anderson Symptom Inventory-Heart Failure
MDASI - MD Anderson Symptom Inventory
M-ESAS for critically ill - Modified Edmonton Symptom Assessment System for critically ill
M-ESAS - Modified Edmonton Symptom Assessment System
Modified SDS-LASA - Modified Symptom Distress Scale Linear Analogue Self-Assessment
MSAS-Family Caregivers - Memorial Symptom Assessment Scale-Family Caregivers
MSAS - Memorial Symptom Assessment Scale (modifications exist for family caregivers and for hospice staff)
MSAS-SF - Memorial Symptom Assessment Scale-Short Form
OTTAT - Oncology Treatment Toxicity Assessment Tool
POMS - Profile of Mood States
POMS‐SF - Profile of Mood States-Short Form
Revised POMS - Revised Profile of Moods States
RSCL-M - Modified version of Rotterdam Symptom Checklist   
RSCL - Rotterdam Symptom Checklist   
SAS - Symptom Assessment Scale
SDS - Symptom Distress Scale