title: Preliminary investigation of symptom distress in the head and neck patient population: validation of a measurement instrument.
abstract: OBJECTIVE
  Observations indicate that the acute toxicity of chemoradiation for squamous cell carcinoma (SCC) of the head and neck is not the same as that which occurs with radiation therapy alone. Thus, the specific aim of this pilot study was to estimate the reliability and validity of a modified version of a symptom distress scale used to assess the qualitative difference in symptom distress between the 2 populations.
  
  
  METHODS
  Over a period of 4 months a consecutive sample of 56 patients with head and neck cancer were recruited from the Department of Radiation Oncology to take part in our pilot study. The Cancer Disease and Treatment Concern Scale (CDTCS) was modified by adding 15 additional items and called the Head and Neck Distress Scale (HNDS). All dimensions were interrogated with at least four questions and a domain score was generated. In addition, the Head and Neck Radiotherapy Questionnaire (HNRQ), an established 22-item multidimensional questionnaire was also administered by interview after completion of the HNDS.
  
  
  RESULTS
  Fifty-six patients, 32 chemoradiation patients (mean age 64 years) completed the HNDS, taking 8 to 10 minutes to complete. The HNDS scores correlated well with the HNRQ scores (r = 0.835), demonstrating an acceptable level of content and concurrent validity. There was a significant difference in the overall HNDS scores between the chemoradiation group and the radiation therapy group (ANOVA, P = 0.001).
  
  
  CONCLUSIONS
  The HNDS is a valid measure of acute symptom distress and appears able to discriminate between the chemoradiation and radiation alone patients. There is considerable variation in symptoms that cause these patients distress.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Jones
authors.forename: Diane
authors.initials: D
authors.lastname: Hershock
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
authors.forename: Ara A
authors.initials: AA
authors.lastname: Chalian
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: Karen
authors.initials: K
authors.lastname: Schumacher
authors.forename: Morton M
authors.initials: MM
authors.lastname: Kligerman
authors.forename: Jessie A
authors.initials: JA
authors.lastname: Berlin
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological; D011795:Surveys and Questionnaires