Purpose: Symptom assessment in cancer patients is associated with improved quality of life and prolonged survival; we sought to evaluate the use of a systematic symptom assessment tool in VA.
Background: Veterans Affairs (VA) Symptom Assessment Scale (VSAS) is a clinical tool for VA nurses and providers to capture symptom burden in patients with cancer. It includes 10 physical factors (pain, tiredness, anorexia, nausea, vomiting, diarrhea, constipation, shortness of breath at rest and with exertion, and drowsiness) and 3 emotional factors (depression, anxiety, and distress). Each symptom is scored on a scale of 0 (absence) to 10 (worst possible symptom). Here, we report symptom prevalence, VSAS reliability and internal consistency.
Methods: VSAS data were collected from the VA Corporate Data Warehouse. Symptom prevalence at baseline (initial hematology or oncology visit) and at subsequent follow-up is described. Reliability was assessed using factor-level test-retest correlation within a one week time period. Internal consistency and reliability of “physical” and “emotional” factors were assessed using Cronbach’s alpha.
Results: From January 2015 through June 2018, 5,995 patients were administered 21,761 VSAS assessments in two VA medical centers. At baseline, patients were most likely to report tiredness (68%), shortness of breath with exertion (49%), and pain (45%). Severe symptoms (scores 7-10) included tiredness (23%), pain (17%), and shortness of breath with exertion (13%). The most common symptoms recorded on follow-up were tiredness (70%; 21% severe), shortness of breath with exertion (51%; 17% severe), and pain (45%; 11% severe). Factor correlation upon retesting within one week was moderate, ranging from 0.40 to 0.62. Internal consistency across all factors was high with a Cronbach alpha of 0.86. Internal reliability of physical and emotional symptoms was also high at 0.81 and 0.87, respectively.
Conclusions: Cancer patients treated in the VA have a high symptom burden. The most prevalent symptoms were pain, tiredness, and shortness of breath. We evaluated reliability and consistency of VSAS factors, validating this method of measuring and documenting cancer-related symptoms. This preliminary report establishes VSAS as a tool that can be implemented widely within the VA with the goal of improving quality of care in VA oncology patients.
