Therapy-Related Symptom Checklist Use During Treatments at a Cancer Center

Phoebe D. Williams, PhD, RN, FAAN; Kathleen M. Graham, MS, BSN, RN, APNP-BC, AOCN, CNS; Deborah L. Storlie, RN, NC; Therese M. Pedace, BSN, RN; Kurt V. Haeflinger, BS; David D. Williams, MPH; Diane Otte, MS, RN, OCN; Jeff A. Sloan, PhD; Arthur R. Williams, PhD, MA, MPA


Cancer Nurs. 2013;36(3):245-254. 

In This Article


Participants: Sociodemographic and Clinical Characteristics

As Table 1 shows, the only statistically significant baseline difference between subjects in G1 and G2 was age. At group means, G1 subjects on average were 4.09 years older than those in G2 (P = .03); however, there is no statistically significant difference in median age. The GEE equations used in this study are age adjusted. Comparisons also were done (not shown here) of demographics between the 696 observations with results similar to those in Table 1 .

Outcome Data, Main Results

Primary Outcomes As noted previously, the primary study hypothesis was the effect of TRSC group (G2) assignment on patients. The results of the GEE used to measure this effect are shown in Table 2 .

As anticipated, the largest single effect on HRQOL was the baseline HRQOL covariate. Placement in the TRSC group raised quality of life on average by 3.31 points. A 3-point change on this measure is considered clinically significant. Male gender was associated on average with a lowered quality of life of 3.24 points. None of the other covariates were statistically significant.

Secondary Outcomes An outcome of secondary interest was the effect of TRSC group placement on the number of symptoms identified and managed. Generalized estimating equation results are shown in Table 3 .

Placement in the TRSC group (G2) had a strong effect on the number of symptoms documented and managed (P < .001). The number of symptoms documented and managed was on average 3.76 more than in G1. Stage also had an effect on the number of symptoms reported. The number of symptoms documented and managed increased by 0.76 for each stage greater than stage I, the reference stage (P < .03). The interaction between TRSC group placement and the number of days postbaseline was strong, with the number of symptoms declining on average about 0.015 each day postbaseline in G2. In summary, a greater number of symptoms was identified and managed in G2 than in the standard-of-care cohort, and in G2, the number of symptoms declined by about 1.5 every 100 days postbaseline more than in the standard-of-care cohort.

Other Outcomes of Clinical Interest

As in earlier studies,[4–8,27,33,48,50] the TRSC total scores, the HRQOL-LASA, and Karnofsky all correlated significantly (P < .001) and in the expected directions. The Pearson correlations between the Karnofsky, HRQOL, and total TRSC score in the current study were 0.42 and -0.47, respectively, and between the HRQOL and TRSC, -0.47. The correlation between the total TRSC score and the total number of symptoms reported was 0.74, which suggests that the number of symptoms reported by patients on the TRSC may capture both frequency and intensity.

Additionally, it should be noted that fewer than 2% of patients seen have added symptoms to the checklist, although 5 blank spaces are available to do so.[4–8,27,33,48,50–52] Physical and psychological symptoms are included in the TRSC. The 25 symptoms on the TRSC are as follows: taste change, loss of appetite, nausea, vomiting, weight loss, sore mouth, cough, sore throat, difficulty swallowing, jaw pain, shortness of breath, numbness of fingers/toes, feeling sluggish, depression, difficulty concentrating, fever, bruising, bleeding, hair loss, skin changes, soreness in vein where chemotherapy was given, difficulty sleeping, pain, decreased interest in sexual activity, constipation. Consistent with the literature,[4–9,27,33,48,50–52] among the most frequently occurring and severe symptoms marked on the TRSC and reported as being managed were loss of appetite and nausea.