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J Thorac Oncol. 2008 Oct;3(10):1137-45. doi: 10.1097/JTO.0b013e3181861729.

Symptom assessment in relapsed small cell lung cancer: cross-validation of the patient symptom assessment in lung cancer instrument.

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Analysis Group, Inc., Boston, Massachusetts, USA.



Lung cancer symptoms can be burdensome for patients with small cell lung cancer (SCLC). Patient Symptom Assessment in Lung Cancer (PSALC), a self-report scale for assessing SCLC symptom burden, was developed and validated previously using intravenous topotecan clinical trial data. This study cross-validates the PSALC using oral topotecan (OT) trial data.


Data were analyzed from a randomized, open-label, multicenter trial including 71 patients with relapsed SCLC receiving OT with best supportive care and 70 patients receiving best supportive care alone. PSALC and EQ-5D were administered at baseline and at 3-week intervals. Internal consistency, reliability, construct validity, and responsiveness were evaluated.


Only one factor was indicated in factor analysis, hence PSALC total score (PSALC-TS) was used for psychometric analysis. Internal consistency was supported by Cronbach's alpha of 0.78. Construct validity was supported by significant associations of higher PSALC-TS (higher symptom burden) with worse Eastern Cooperative Oncology Group performance status and by correlations of PSALC-TS with EQ-5D utility index and visual analog scale score (all p < 0.001). Reliability was supported by intraclass correlation coefficient of 0.68 (using PSALC-TS before clinical status change) and concordance correlation coefficient of 0.69 (using PSALC-TS at baseline and before first visit). PSALC-TS was responsive to clinical status change from baseline to tumor response (responsiveness statistic = -0.99) and to tumor progression (responsiveness statistic = 0.94).


Consistent with prior psychometric results, this cross-validation study using OT trial data showed acceptable validity, reliability, and responsiveness of the PSALC scale, further supporting its use to measure symptom burden in previously treated SCLC.

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