Validation of the Chinese version of the Head and Neck Patient Symptom Checklist for measuring nutrition impact symptoms during radiotherapy in patients with head and neck cancer

  • Sanli Jin
  • Qian LuEmail author
  • Dong Pang
  • Yan Sun
  • Shaowen Xiao
  • Baomin Zheng
  • Hangjing Cui
Original Article



The Head and Neck Patient Symptom Checklist (HNSC) is a valid tool for measuring nutrition impact symptoms (NIS) specific to head and neck cancer (HNC) patients. This study aimed to translate the HNSC into Chinese and to evaluate its psychometric properties in Chinese HNC patients treated with radiotherapy.


The HNSC was translated into Chinese following standard forward- and back-translation procedures. Three instruments, the Chinese version of HNSC, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and Patient-Generated Subjective Global Assessment (PG-SGA), were answered by 116 HNC patients, of whom 11 were submitted to the test–retest in 3–7 days. The criterion and convergent validities were confirmed by measuring the relations of the HNSC score with the PG-SGA and EORTC QLQ-C30, respectively. The discriminant validity was evaluated through known group analysis. Reliability was evaluated by means of Cronbach’s alpha and test–retest using the correlation coefficient.


Criterion validity was 0.767 for intensity dimension and 0.795 for interference dimension, respectively. Convergent validity was confirmed by the significant correlations between the HHSC score and most domains of QLQ-C30. The comparison among the groups demonstrated good discriminant validity. The Cronbach’s alpha was 0.787 for intensity dimension and 0.797 for interference dimension, respectively. The test–retest reliability was 0.845 for intensity dimension and 0.883 for interference dimension, respectively.


The Chinese version of HNSC demonstrated favorable validity and reliability. It can be used in identification of NIS and development of symptom management program in HNC patients in China.


Head and neck cancer Nutrition impact symptom Head and Neck Patient Symptom Checklist Reliability Validity 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


The corresponding author has full control of all primary data and agrees to allow the journal to review the data if requested.


  1. 1.
    Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China. CA Cancer J Clin 66(2):115–132CrossRefGoogle Scholar
  2. 2.
    Lavaf A, Genden EM, Cesaretti JA, Packer S, Kao J (2008) Adjuvant radiotherapy improves overall survival for patients with lymph node-positive head and neck squamous cell carcinoma. Cancer 112(3):535–543CrossRefGoogle Scholar
  3. 3.
    Sanguineti G, Forastiere AA (2008) Determining the survival benefit of adjuvant radiotherapy in patients with node-positive head and neck cancer. Nat Clin Pract Oncol 5(12):694–695CrossRefGoogle Scholar
  4. 4.
    De Sanctis V, Bossi P, Sanguineti G, Trippa F, Ferrari D, Bacigalupo A et al (2016) Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus statements. Crit Rev Oncol Hematol 100:147–166CrossRefGoogle Scholar
  5. 5.
    Schindler A, Denaro N, Russi EG, Pizzorni N, Bossi P, Merlotti A, Spadola Bissetti M, Numico G, Gava A, Orlandi E, Caspiani O, Buglione M, Alterio D, Bacigalupo A, de Sanctis V, Pavanato G, Ripamonti C, Merlano MC, Licitra L, Sanguineti G, Langendijk JA, Murphy B (2015) Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus. Crit Rev Oncol Hematol 96(2):372–384CrossRefGoogle Scholar
  6. 6.
    Farhangfar A, Makarewicz M, Ghosh S, Jha N, Scrimger R, Gramlich L, Baracos V et al (2014) Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival. Oral Oncol 50(9):877–883CrossRefGoogle Scholar
  7. 7.
    Kubrak C, Olson K, Jha N, Jensen L, McCargar L, Seikaly H, Harris J, Scrimger R, Parliament M, Baracos VE et al (2010) Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck 32(3):290–300Google Scholar
  8. 8.
    Ganzer H, Touger-Decker R, Parrott JS, Murphy BA, Epstein JB, Huhmann MB (2013) Symptom burden in head and neck cancer: impact upon oral energy and protein intake. Support Care Cancer 21(2):495–503CrossRefGoogle Scholar
  9. 9.
    Kubrak C, Olson K, Jha N, Scrimger R, Parliament M, McCargar L, Koski S, Baracos VE et al (2013) Clinical determinants of weight loss in patients receiving radiation and chemoirradiation for head and neck cancer: a prospective longitudinal view. Head Neck 35(5):695–703CrossRefGoogle Scholar
  10. 10.
    Kubrak C, Olson K, Baracos VE (2013) The head and neck symptom checklist©: an instrument to evaluate nutrition impact symptoms effect on energy intake and weight loss. Support Care Cancer 21(11):3127–3136CrossRefGoogle Scholar
  11. 11.
    Langius JA, Bakker S, Rietveld DH, Kruizenga HM, Langendijk JA, Weijs PJ, Leemans CR et al (2013) Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer 109(5):1093–1099CrossRefGoogle Scholar
  12. 12.
    Murphy BA, Dietrich MS, Wells N, Dwyer K, Ridner SH, Silver HJ, Gilbert J, Chung CH, Cmelak A, Burkey B, Yarbrough WG, Sinard R, Netterville J (2010) Reliability and validity of the Vanderbilt Head and Neck Symptom Survey: a tool to assess symptom burden in patients treated with chemoradiation. Head Neck 32(1):26–37Google Scholar
  13. 13.
    Rosenthal DI, Mendoza TR, Chambers MS, Burkett VS, Garden AS, Hessell AC, Lewin JS, Ang KK, Kies MS, Gning I, Wang XS, Cleeland CS (2008) The M. D. Anderson symptom inventory–head and neck module, a patient-reported outcome instrument, accurately predicts the severity of radiation-induced mucositis. Int J Radiat Oncol Biol Phys 72(5):1355–1361CrossRefGoogle Scholar
  14. 14.
    Schmidt KN, Olson K, Kubrak C, Parliament M, Ghosh S (2013) Validation of the Head and Neck Patient Symptom Checklist as a nutrition impact symptom assessment tool for head and neck cancer patients. Support Care Cancer 21(1):27–34CrossRefGoogle Scholar
  15. 15.
    Mundform DJ, Shaw DG, Ke TL (2005) Minimum sample size recommendations for conducting factor analysis. IJT 5(2):159–168Google Scholar
  16. 16.
    Mallick S, Benson R, Rath GK (2016) Radiation induced oral mucositis: a review of current literature on prevention and management. Eur Arch Otorhinolaryngol 273(9):2285–2293CrossRefGoogle Scholar
  17. 17.
    Ruo Redda MG, Allis S (2006) Radiotherapy-induced taste impairment. Cancer Treat Rev 32(7):541–547CrossRefGoogle Scholar
  18. 18.
    Maes A, Huygh I, Weltens C, Vandevelde G, Delaere P, Evers G, Van den Bogaert W (2002) De Gustibus: time scale of loss and recovery of tastes caused by radiotherapy. Radiother Oncol 63(2):195–201CrossRefGoogle Scholar
  19. 19.
    Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56(8):779–785CrossRefGoogle Scholar
  20. 20.
    Ottery FD (1994) Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin Oncol 21(6):770–778Google Scholar
  21. 21.
    Gabrielson DK, Scaffidi D, Leung E, Stoyanoff L, Robinson J, Nisenbaum R, Brezden-Masley C, Darling PB et al (2013) Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting. Nutr Cancer 65(2):234–239CrossRefGoogle Scholar
  22. 22.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefGoogle Scholar
  23. 23.
    Rw B (1970) Back-translation for cross-culture research. J Cross-Cult Psychol 3(1):185–216Google Scholar
  24. 24.
    Kubrak C, Jensen L (2007) Critical evaluation of nutrition screening tools recommended for oncology patients. Cancer Nurs 30(5):E1–E6CrossRefGoogle Scholar
  25. 25.
    Cook DA, Beckman TJ (2006) Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med 119(2):166.e7–166.16CrossRefGoogle Scholar
  26. 26.
    Mohamad MM, Sulaiman NL, Sern LC, Salleh KM (2015) Measuring the validity and reliability of research instruments. Procedia Soc Behav Sci 204:164–171CrossRefGoogle Scholar
  27. 27.
    Baracos VE (2006) Cancer-associated cachexia and underlying biological mechanisms. Annu Rev Nutr 26:435–461CrossRefGoogle Scholar
  28. 28.
    Epstein JB, Huhmann MB (2011) Dietary and nutritional needs of patients undergoing therapy for head and neck cancer. J Am Dent Assoc 142(10):1163–1167CrossRefGoogle Scholar
  29. 29.
    Datema FR, Ferrier MB, Baatenburg de Jong RJ (2011) Impact of severe malnutrition on short-term mortality and overall survival in head and neck cancer. Oral Oncol 47(9):910–914CrossRefGoogle Scholar
  30. 30.
    Vera-Llonch M, Oster G, Hagiwara M, Sonis S (2006) Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 106(2):329–336CrossRefGoogle Scholar
  31. 31.
    Sapir E, Tao Y, Feng F, Samuels S, El Naqa I, Murdoch-Kinch CA, Feng M, Schipper M, Eisbruch A (2016) Predictors of dysgeusia in patients with oropharyngeal cancer treated with chemotherapy and intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 96(2):354–361CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Medical & Surgical Nursing, School of NursingPeking UniversityBeijingChina
  2. 2.Department of Radiation OncologyPeking University Cancer HospitalBeijingChina

Personalised recommendations