Friedman DR

Background: Oncologists are often not aware of the symptom burden their patients experience. Patient reported outcome (PRO) assessments are tools to measure symptoms. Higher symptom burden is associated with worse quality of life (QOL) and shorter survival, and implementation of PRO assessments is associated with improved QOL and longer survival. The Veteran Symptom Assessment Scale (VSAS) is a PRO template that is incorporated into the Veteran Administration’s (VA) computer patient record system. It is used by health care team members to record patient symptoms and is consistent and reproducible. However, as VSAS is administered at patient visits, it cannot measure between-visit symptoms. Thus, we sought to develop a platform by which veterans receiving hematology- oncology care can directly report their symptoms at any time.

Description: VA Office of Connected Care developed a text messaging platform called “Annie” which includes different disease-based assessment and automated management tools. Annie is named after Lieutenant Annie G. Fox, Chief Nurse in the Army Nurse Corps at Hickman Field, Pearl Harbor and the first woman to receive the Purple Heart for combat.

We developed an oncology symptom module in Annie that incorporates the VSAS symptoms, with a rating scale of 1 – 10 (1 = least severe, 10 = most severe). Veterans signed up for the oncology module receive weekday reminders to report symptoms, but may report symptoms on any day and time, even multiple times a day. After reporting a symptom and severity, a message with advice is texted to the veteran. This text is provided for self-help purposes, and does not replace individualized advice provided by an oncology nurse or provider. The Annie oncology module is available throughout the VA.

Implications: The Annie oncology module may improve implementation of VSAS at VA facilities, by removing the necessity for nurse administration. Using Annie will help VA facilities meet quality of care goals recommended by the American Society of Clinical Oncology and American College of Surgeon and will improve measurement of cancer related symptoms, a first step to developing symptom management tools for VA providers.

Background: Oncologists are often not aware of the symptom burden their patients experience. Patient reported outcome (PRO) assessments are tools to measure symptoms. Higher symptom burden is associated with worse quality of life (QOL) and shorter survival, and implementation of PRO assessments is associated with improved QOL and longer survival. The Veteran Symptom Assessment Scale (VSAS) is a PRO template that is incorporated into the Veteran Administration’s (VA) computer patient record system. It is used by health care team members to record patient symptoms and is consistent and reproducible. However, as VSAS is administered at patient visits, it cannot measure between-visit symptoms. Thus, we sought to develop a platform by which veterans receiving hematology- oncology care can directly report their symptoms at any time.

Description: VA Office of Connected Care developed a text messaging platform called “Annie” which includes different disease-based assessment and automated management tools. Annie is named after Lieutenant Annie G. Fox, Chief Nurse in the Army Nurse Corps at Hickman Field, Pearl Harbor and the first woman to receive the Purple Heart for combat.

We developed an oncology symptom module in Annie that incorporates the VSAS symptoms, with a rating scale of 1 – 10 (1 = least severe, 10 = most severe). Veterans signed up for the oncology module receive weekday reminders to report symptoms, but may report symptoms on any day and time, even multiple times a day. After reporting a symptom and severity, a message with advice is texted to the veteran. This text is provided for self-help purposes, and does not replace individualized advice provided by an oncology nurse or provider. The Annie oncology module is available throughout the VA.

Implications: The Annie oncology module may improve implementation of VSAS at VA facilities, by removing the necessity for nurse administration. Using Annie will help VA facilities meet quality of care goals recommended by the American Society of Clinical Oncology and American College of Surgeon and will improve measurement of cancer related symptoms, a first step to developing symptom management tools for VA providers.

Background: Oncologists are often not aware of the symptom burden their patients experience. Patient reported outcome (PRO) assessments are tools to measure symptoms. Higher symptom burden is associated with worse quality of life (QOL) and shorter survival, and implementation of PRO assessments is associated with improved QOL and longer survival. The Veteran Symptom Assessment Scale (VSAS) is a PRO template that is incorporated into the Veteran Administration’s (VA) computer patient record system. It is used by health care team members to record patient symptoms and is consistent and reproducible. However, as VSAS is administered at patient visits, it cannot measure between-visit symptoms. Thus, we sought to develop a platform by which veterans receiving hematology- oncology care can directly report their symptoms at any time.

Description: VA Office of Connected Care developed a text messaging platform called “Annie” which includes different disease-based assessment and automated management tools. Annie is named after Lieutenant Annie G. Fox, Chief Nurse in the Army Nurse Corps at Hickman Field, Pearl Harbor and the first woman to receive the Purple Heart for combat.

We developed an oncology symptom module in Annie that incorporates the VSAS symptoms, with a rating scale of 1 – 10 (1 = least severe, 10 = most severe). Veterans signed up for the oncology module receive weekday reminders to report symptoms, but may report symptoms on any day and time, even multiple times a day. After reporting a symptom and severity, a message with advice is texted to the veteran. This text is provided for self-help purposes, and does not replace individualized advice provided by an oncology nurse or provider. The Annie oncology module is available throughout the VA.

Implications: The Annie oncology module may improve implementation of VSAS at VA facilities, by removing the necessity for nurse administration. Using Annie will help VA facilities meet quality of care goals recommended by the American Society of Clinical Oncology and American College of Surgeon and will improve measurement of cancer related symptoms, a first step to developing symptom management tools for VA providers.

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.

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.

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.