Primary References

1. Hollen, P.J., Gralla, R.J., & Kris, M.G. (1995). An overview of the Lung Cancer Symptom Scale. In R.J. Gralla, & C.M. Moinpour (Eds.), Assessing quality of life in patients with lung cancer: A guide for clinicians (pp. 57-63). New York: NCM Publishers. [Monograph, Quality of Life Symposium, 7th World Conference on Lung Cancer, Colorado Springs, Colorado, June, 1994].

2. Hollen, P.J., Gralla, R.J., Kris, M.G., & Potanovich, L.M. (1993). Quality of life assessment in individuals with lung cancer: Testing the Lung Cancer Symptom Scale (LCSS). European Journal of Cancer, 29A, S51-S58.

3. Hollen, P.J., Gralla, R.J., Kris, M.G., & Cox, C. (1994). Quality of life during clinical trials: Conceptual model for the Lung Cancer Symptom Scale (LCSS). Supportive Care in Cancer, 2, 213-222.

4. Hollen, P.J., Gralla, R.J., Kris, M.G., Cox, C., Belani, C.P., Grunberg, S.M., Crawford, J., & Neidhart, J.A. (1994). Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies: Psychometric assessment of the Lung Cancer Symptom Scale. Cancer, 73, 2087-2098.

5. Hollen, P.J., Gralla, R.J., Kris, M.G., Eberly, S.W., & Cox, C. (1999). Normative data and trends in quality of life from the Lung Cancer Symptom Scale (LCSS). Supportive Care in Cancer, 7, 140-148.

6. Hollen, P.J., Gralla, R.J., Cox, C., Eberly, S.W., & Kris, M.G. (1997). A dilemma in analysis: Issues in the serial measurement of quality of life in patients with advanced lung cancer. Lung Cancer, 18. 119-136.

The LCSS is designed as a site-specific measure of quality of life (QL), particularly for use in clinical trials. It evaluates six major symptoms associated with lung malignancies and their effect on overall symptomatic distress, functional activities, and global QL. The philosophy behind the development of the LCSS is to provide a practical QL measure that reduces patient and staff burden in serial measurement of QL during the course of the trial. It captures in detail those dimensions most likely to be influenced by therapeutic interventions and evaluates other dimensions globally. It consists of two scales: one completed by the patient and an optional one for health care professionals ("counterpart observer") to provide context.

Primary Developers: Patricia J. Hollen, Richard J. Gralla, Mark G. Kris

Administration: Face-to-face interview initially for demonstration of visual analogue scale (VAS) with a simple example question related to the weather, with telephone interview acceptable once patient is familiar with VAS.

Time to Complete:
Patient scale: 8 minutes initially for demonstration of VAS; 3-5 minutes for
subsequent administrations.     Observer scale: 2 minutes.

Number of Items:
Patient scale: 9     Observer scale: 6

Number of QL Dimensions/Domains:
Five, with physical and functional in detail, and others captured globally.

Names of QL Dimensions/Domains:
To measure in depth those areas most relevant to evaluating health interventions, this instrument concentrates on the physical and functional QL dimensions in patients with lung cancer. Other dimensions (psychological, social, and spiritual) are captured in less detail by summation items.

Scaling of items:
Patient scale: 9 visual analogue scales (100 mm horizontal line). Patient puts a mark on line to indicate intensity of response to the items in question (0 = lowest rating; 100 = highest rating). Observer scale: 5-point categorical scale (100 = none; 75 = mild; 50 = moderate; 25 = marked; 0 = severe).

Scoring:
Patient scale: Scores equal length of line marked by patient. An average of the aggregate score of all 9 items is used for a total score. In addition, a subscore using the mean of all 6 major symptoms ("average symptom burden index"), the single QL item, and/or individual items to report specific areas of change can be used. Observer scale: Score equals point value chosen by observer for each item. Aggregate score is used as well as average symptom burden index and/or individual items for specific areas of change.

Reliability: Good psychometric properties reported.^1-4

Validity: Good psychometric properties reported.^1-4

Responsiveness:
Good sensitivity to all levels of the Karnofsky scale; reported as a part of construct validity.⁴

Normative Data: Reported.⁵

Minimally Important Difference:
Clinical versus statistical significance provided by developers (with empirical rationale).⁴

Analysis Methods: Reported.⁶

Research Use:
Used on six continents, in many countries, and in many chemotherapy and RT trials.

Languages:
See translation chart; contact Dr. Hollen if development of other versions is needed.

Date of Update: 9/24/04