title: Reliability and validity of the Vanderbilt Head and Neck Symptom Survey: a tool to assess symptom burden in patients treated with chemoradiation.
abstract: BACKGROUND
  We describe the development and validation of the Vanderbilt Head and Neck Symptom Survey (VHNSS), which was designed to screen for tumor- and treatment-specific symptoms in patients with head and neck cancer undergoing concurrent chemoradiation (CCR).
  
  
  METHODS
  Using a 2-step card sort method, we identified high-impact and high-frequency toxicities in patients with head and neck cancer treated with CCR. This resulted in a 28-item questionnaire which scores symptoms on a 0 to 10 scale (none to severe). The tool was validated using data collected from 5 supportive care studies comprising a total sample of 332 patients with head and neck cancer.
  
  
  RESULTS
  Responses to the VHNSS items demonstrated a very consistent pattern (Cronbach's alpha = 0.943) with each item contributing substantially to the global index. Five symptom subscales were identified including "Nutrition," "Pain," "Voice," "Swallow," and "Mucous/Dry Mouth." Each of the cluster scores demonstrated good internal consistency. The pattern of associations between the VHNSS and established tools indicated appropriate convergence and divergence. Comparison of global and subscale scores and objective measure were also in the expected direction providing further evidence of validity.
  
  
  CONCLUSIONS
  The findings provide support that the VHNSS is a valid and reliable tool to assess head and neck-specific symptom burden and function loss. Further research to evaluate this screening tool as a part of a systems approach to supportive care is warranted.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, USA. barbara.murphy@vanderbilt.edu
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Murphy
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Nancy
authors.initials: N
authors.lastname: Wells
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dwyer
authors.forename: Sheila H
authors.initials: SH
authors.lastname: Ridner
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Silver
authors.forename: Jill
authors.initials: J
authors.lastname: Gilbert
authors.forename: Christine H
authors.initials: CH
authors.lastname: Chung
authors.forename: Anthony
authors.initials: A
authors.lastname: Cmelak
authors.forename: Brian
authors.initials: B
authors.lastname: Burkey
authors.forename: Wendell G
authors.initials: WG
authors.lastname: Yarbrough
authors.forename: Robert
authors.initials: R
authors.lastname: Sinard
authors.forename: James
authors.initials: J
authors.lastname: Netterville
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D016000:Cluster Analysis; D017281:Cost of Illness; D003680:Deglutition Disorders / Q000209:etiology; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D006306:Health Surveys; D006801:Humans; D010146:Pain / Q000209:etiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014832:Voice Disorders / Q000209:etiology; D014987:Xerostomia / Q000209:etiology