Condensed Memorial Symptom Assessment Scale (CMSAS)

Background:

With the introduction and growing acceptance of the biopsychosocial model of health, it is becoming increasingly common to assess the quality of life of patients before, during, or after serious illness, pain, or surgery. Palliative carers are especially concerned with the well-being of patients who may be suffering from psychological as well as physical symptoms. The effects of psychological processes are now recognised as major contributors to our physical health. For this reason, the MSAS-SF was developed and validated for clinicians who require a quick, accurate, and multi-dimensional measure of patient quality of life.

Psychometrics:

The psychometric properties of the Condensed Memorial Symptom Assessment Scale (CMSAS) are discussed in Chang, Hwang, Kasimis, & Thaler, (2004).

Author of Tool:

Chang, V. T., Hwang, S. S., Kasimis, B., & Thaler, H. T.

Key references:

Primary use / Purpose:

The Condensed Memorial Symptom Assessment Scale (CMSAS) is a 14 item inventory rated on a 5 point Likert-type scale. Its purpose is to measure the frequency, severity, and distress associated with, 32 separate, multidimensional symptoms experienced by patients. The CMSAS is based on the previously developed and validated instrument, the Memorial Symptom Assesment Scale – Short Form (MSAS-SF).

Memorial Symptom Assessment Scale Subscales

            The scoring of the MSAS-SF  yields several validated subscale scores.

A 10 item MSAS Global Distress Index (MSAS-GDI) is considered to be a measure of overall symptom distress. The GDI is the average of the frequency of 4 prevalent psychological symptoms (feeling sad, worrying, feeling irritable, and feeling nervous) and the distress associated with 6 prevalent physical symptoms (lack of appetite, lack of energy, pain, feeling drowsy, constipation, dry mouth).

MSAS SF GDI = (feeling sad, worrying, feeling irritable, feeling nervous, lack of appetite, lack of energy, pain, feeling drowsy, constipation, dry mouth)/10

            The Physical Symptom Subscale score (MSAS-PHYS) is the average of the distress associated with 12 prevalent physical symptoms: lack of appetite, lack of energy, pain, feeling drowsy, constipation, dry mouth, nausea, vomiting, change in taste, weight loss, feeling bloated, and dizziness. Note that the scaling is in increments of 0.8, with zero for no symptom, 0.8 for symptom present but no distress, and upwards for increasing levels of distress.

MSAS SF PHYS = (lack of appetite, lack of energy, pain, feeling drowsy, constipation, dry mouth, nausea, vomiting, change in taste, weight loss, feeling bloated, and dizziness) / 12

            The Psychological Symptom Subscale score (MSAS-PSYCH) is the average of the frequency associated with 6 prevalent psychological symptoms: worrying, feeling sad, feeling nervous, difficulty sleeping, feeling irritable, and difficulty concentrating.  Scoring is in increments of one, with zero for no symptom to 4 for “almost constantly”.

MSAS SF PSYCH = (worrying, feeling sad, feeling nervous, difficulty sleeping, feeling irritable, and difficulty concentrating)/6

            The Total MSAS score (TMSAS) is the average of the symptom scores of all 32 symptoms in the MSAS instrument.

            In the short form, there is only one dimension for each symptom, distress for physical symptoms and frequency for psychological symptoms. The sequence of symptoms in the short form is different from that in the long form.

Scoring of physical symptoms in the MSAS-SF is as follows:

Zero    if the symptom is not present

• if the symptom is present but causes no distress
• if the symptom is present and causes a little bit of distress
• if the symptom is present and causes somewhat of distress
• if the symptom is present and causes quite a bit of distress
• if the symptom is present and causes very much distress.

Scoring of psychological symptoms is:

• if the symptom is absent
• if the symptom is present and occurs rarely
• if the symptom is present and occurs occasionally
• if the symptom is present and occurs frequently
• if the symptom is present and occurs almost constantly.

Condensed Memorial Symptom Assessment Scale (CMSAS)

How much did this symptom bother or distress you in the past 7 days?

Symptom	Present	Not at all	A little Bit	Some what	Quite a bit	Very much
Lack of energy*	Y     N	0	1	2	3	4
Lack of appetite*	Y     N	0	1	2	3	4
Pain*	Y     N	0	1	2	3	4
Dry mouth*	Y     N	0	1	2	3	4
Weight Loss*	Y     N	0	1	2	3	4
Feeling drowsy*	Y     N	0	1	2	3	4
Shortness of breath*	Y     N	0	1	2	3	4
Constipation*	Y     N	0	1	2	3	4
Difficulty sleeping*	Y     N	0	1	2	3	4
Difficulty concentrating	Y     N	0	1	2	3	4
Nausea*	Y     N	0	1	2	3	4

How frequently did these symptoms occur during the last week?

Symptom	Present	Rarely	Occasionally	Frequently	Almost constantly
Worrying	Y      N	1	2	3	4
Feeling sad	Y      N	1	2	3	4
Feeling nervous	Y      N	1	2	3	4

The scoring is similar to that for the MSAS Short Form

For the top box (physical symptoms), weights of zero for N, 0.8 for not at all, 1.6 for a little bit, 2.4 for somewhat, 3.2 for quite a bit, and 4.0 for very much.  The average of the starred symptoms would be the PHYS subscale.

For the bottom box (psychological symptoms), weights of zero for N, 1 for rarely, 2 for occasionally, 3 for frequently, 4 for almost constantly. The average of the 3 symptoms would be the PSYCH subscale.