The Therapy-Related Symptom Checklist (Oncology): The Asian Results

Tuesday, 14 July 2009

Phoebe D. Williams, PhD, RN, FAAN
University of Kansas Medical Center, School of Nursing, Kansas City, KS
Ubolrat Piamjariyakul, PhD, RN
School of Nursing, University of Kansas Medical Center, Kansas City, KS
Arthur R. Williams, PhD, MPA, MA
Health Outcomes and Health Services Research, Children's Mercy Hospital & Clinics, Kansas City, MO

Learning Objective 1: understand oncology symptom monitoring in Asian patients.

Learning Objective 2: understand the use of a standardized checklist to optimize care.

Purpose: The Therapy-Related Symptom Checklist (TRSC) was used to examine symptoms reported by 547 Asian adults during cancer treatments.

Methods: Study done in Thailand, China, and Philippines (n=225, 222, 100, respectively). Sample: Mean age=52.7 years (SD=12.6); 58% female; 82% married. Education: 72 % high school/ lower, 28 % some college/ higher. Treatments: Chemotherapy (CT) (n=252) primarily for GI track, breast, lung; Radiation Therapy (RT) (n=129) for cervical, GI track, Breast; or Combined CT-RT (n=162) for cervical, nasopharyngeal, lung, and GI track cancer. Instruments: TRSC (25-item, scale 0-4); demographic; self-care form; Karnofsky scale. Analyses: Descriptive; correlational; Exploratory Factor Analysis of TRSC using principal components extraction with VARIMAX rotation; retained factors/components loading with Eigenvalues >1.0.

Results: Seven factors/components/subscales accounted for 55% of variance; factor loadings (.45 cut-off score) and TRSC items weighting on each Factor: 1) Nausea/Eating, 5 items; 2) Oropharynx, 4 items; 3) Fatigue, 4 items; 4) Pain/Sleep, 4 items; 5) Fever, 3 items; 6) Respiratory, 2 items; and 7) Skin-related, 2 items. Chemotherapy(CT) patients reported severe symptoms on TRSC factors/components Skin-related, Nausea/Eating, Fatigue, while RT patients reported severe symptoms on TRSC factors/components Nausea/Eating, Fatigue, Pain/Sleep; and, Skin-related, Nausea/Eating, Pain/Sleep, by Combined CT-RT patients. Patients reported complementary medicine use; self-care strategies found helpful. Medicines also were prescribed to control symptoms (e.g., pain, nausea).  Karnofsky inversely correlated with TRSC (r = -.37, p < .001); TRSC Cronbach alpha=.81.

Conclusion: The first 3 of 7 Asian TRSC factors/components with acceptable Cronbach; similar to US findings based on principal components analysis (Williams et al, 2006). Ongoing analyses of other components. Symptom severity reporting enables caregivers to prioritize, evaluate interventions. Standardized self-report checklists (TRSC) facilitate oncology symptom monitoring/care.