ATS American Thoracic Society
Recent Abstracts

Lung Cancer Symptom Scale

Name of Questionnaire

Lung Cancer Symptom Scale (LCSS)


The LCSS is designed as a disease- and site-specific measure of quality of life particularly for use in clinical trials. It evaluates six major symptoms associated with lung mallignancies and their effect on overal symptomatic distress, functional activities, and global quality of life. The philosophy behind the development of the LCSS is to provide a practical qualityo f life measure that reduced patient and staff burden in serial measurement of quality of life 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.


PJ Hollen, RJ Gralla, MG Kris


Patricia Hollen, PhD, RN
Northeastern University
Robinson Hall, Suite 401
Boston, MA 02115-5000

fax: 617-373-3050


Cost & availability

Instrument is copyrighted and an agreement form must be signed for permission to use.


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 1 .

Time to complete

Patient scale: 8 minutes initially for demonstration of visual analogue scale, 3-5 minutes for subsequent demonstrations1

Observer scale: 2 minutes

Number of items

Patient scale: 9

Observer scale: 6

Domains & categories

Patient scale: 4

Observer scale: 1

Name of categories/domains

Patient scale: Symptoms, total symptomatic distress, activity status, overall quality of life

Observer scale: Symptoms

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).


Patient scale: Scores equal length of line marked by patient. An aggregate score of all 9 items is used. In addition, a subscore using the mean of all 6 major symptoms ("average symptom burden index") 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.


a. Test-retest/reproducibility Reported 2 , 3
b. Internal consistency Reported 4


Slopes for regression lines obtained between the Karnofsky Performance Scale and each of the LCSS scales were significantly different from zero 4 . Significant correlations between LCSS and KPS for each item except hemoptysis 4 . Good convergent validity for the patient and observer LCSS scales. Good discriminant validity pattern from the Brief Symptom Inventory. Significant correlations with the American Thoracic Society Questionnaire cough and breathlessness subscales, McGill Pain Questionnaire, KPS, Profile of Mood States, and Sickness Impact Profile 4 .


Reported 4

Minimally important difference

Not reported

Research use

Reported - docetaxel with prednisone premedication in advanced non-small cell lung cancer 5 , quality of life analysis of palliative radiotherapy treatment for advanced non-small cell lung cancer 6

Clinical use

Not reported


English, French, Spanish, Dutch/Flemish, Finnish, German, Italian, Polish, Portuguese, and others (26 total)


  1. Hollen, PJ. Personal correspondence, 1999.
  2. Burke MT, Gralla R, Kris M, et al. Subjective evaluation in non-small cell lung cancer: comparison of Karnofsky performance status with a patient generated visual analogue scale measuring activity. Proceedings of the 4th World Conference on Lung Cancer, 1985, Vol 4.
  3. Monras P, Gralla RJ, Burke MT, et al. Development of specific instruments for subjective evaluation of patients with lung cancer: comparison of observer assessment with patient generated visual analogue scales (VAS). Proc Am Soc Clin Oncol 1985;4:251.
  4. Hollen PJ, Gralla RJ, Kris MG, et al. 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 1994;73:2087-98.
  5. Miller VA, Rigas JR, Francis PA, et al. Phase II trial of a 75-mg/m2 dose of docetaxel with prednisone premedication for patients with advanced non-small cell lung cancer. Cancer 1995;75:968-72.
  6. Lutz ST, Huang DT, Ferguson CL, et al. A retrospective quality of life analysis using the Lung Cancer Symptom Scale in patients treated with palliative radiotherapy for advanced nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 1997;37:117-22.
  7. Hollen PJ, Gralla RJ, Kris MG, et al. Normative data and trends in quality of life from the Lung Cancer Symptom Scale (LCSS). Support Care Cancer 1999; 7:140-8.


Normative data have been reported 7 . Contact developers for additional information regarding psychometric properties, languages available, and complete bibliography.

Date of information

May 1999

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