Journal of Pain and Symptom Management
Volume 38, Issue 5 , Pages 691-697, November 2009

Validation of a Simplified Anorexia Questionnaire

  • Mellar P. Davis, MD, FCCP

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
    • Corresponding Author InformationAddress correspondence to: Mellar P. Davis, MD, FCCP, Cleveland Clinic Foundation, 9500 Euclid Avenue, R35, Cleveland, OH 44195, USA.
    • ,
  • Tugba Yavuzsen, MD

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Jordanka Kirkova, MD

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Declan Walsh, MSc, FACP

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Matthew Karafa, PhD

      Affiliations

    • Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Susan LeGrand, MD, FACP

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Ruth Lagman, MD, MPH

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, The Cleveland Clinic, Cleveland, Ohio, USA

Accepted 1 April 2009.

Abstract 

Context

Anorexia is a common symptom in cancer and is usually assessed by multiple questions and multidimensional questionnaires. A simplified questionnaire would be less burdensome to patients and abbreviate the process.

Objectives

We compared the reliability at one point in time, sensitivity to change over time, and prognostic accuracy of a two-item questionnaire with the Functional Assessment of Anorexia and Cachexia Therapy shortened 12-question version (A/CS-12).

Methods

Individuals with cancer, who were cognitively intact and verbally agreed to participate, completed a two-item questionnaire and A/CS-12 in random order and again seven days later. We compared the direction of response to the summated two-item questionnaire to the validated A/CS-12 score at a single point in time, then intra-patient changes over a seven-day period of time. Scores of both questionnaires were divided into poor, moderate and good appetite and compared to survival using Kaplan-Meyer curves. Bootstrapping was used to construct confidence intervals for estimated probability agreement. Survival analysis also used hazard ratios from a Cox Proportional Hazards model.

Results

One hundred seventeen individuals from a single institution participated, who were either admitted to an inpatient palliative unit or seen in an outpatient/palliative medicine unit. Median age was 58.8 (range 10.7–87.1 years). Agreement at one point in time was 0.64 (95% confidence interval [CI] 0.63 – 0.66). Agreement over time was 0.53 (CI 0.41 – 0.64). The A/CS-12 predicted survival based on scores on Days 1 and 7 (P<0.001), (P=0.003) (HR 0.97 day 1, HR 0.95 day 7), whereas the simplified questionnaire failed to predict survival.

Conclusions

A simplified questionnaire has moderate correlation with the A/CS-12 at one point in time but loses sensitivity over time, and lacks the ability to predict survival. A change in the questionnaire may improve reliability. Changing question 2 of the simplified questionnaire to a neutral form (better, same or worse appetite) may improve sensitivity and prognostic capability.

Key Words: Questionnaire, assessment, anorexia, survival, prognosis

 

 The Harry R. Horvitz Center for Palliative Medicine is a World Health Organization Demonstration Project in Palliative Medicine.

 Web site: www.clevelandclinic.org/palliative.

PII: S0885-3924(09)00730-1

doi:10.1016/j.jpainsymman.2009.03.012

Journal of Pain and Symptom Management
Volume 38, Issue 5 , Pages 691-697, November 2009

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