The linguistic validation process of the Vanderbilt Head and Neck Symptom Survey - Italian Version (VHNSS-IT)

  • Marta MaddaloEmail author
  • Michela Buglione
  • Nadia Pasinetti
  • Luca Triggiani
  • Loredana Costa
  • Stefano M. Magrini
  • Barbara A. Murphy



To linguistically validate the Italian translation of the Vanderbilt Head and Neck Symptom Survey (VHNSS), there is a patient-reported outcome measure to screen for symptoms in the head and neck cancer (HNC) patients population. The goal was to ensure conceptually equivalence with the original version and maintain clarity, ease of use and understanding.


We conducted a multi-step linguistic process (forward translation, backward translation and patient testing) to generate and validate an Italian translation of the VHNSS.


Two intermediate Italian versions were created: The first Italian version was derived from a reconciliation of the three forward translations, and the second Italian version was derived from changes in the first version after the backward translation step. All investigators involved actively discussed possible solutions to produce a translated instrument that maintained a reading and comprehension level accessible by most respondents, without altering the meaning and content of the original source. During the patient testing step, only two patients reported problems with items comprehension and the rate of comprehension problems per single item was lower than expected. This phase allowed patients to give suggestion in order to make items clearer and easier to understand: 43% of patients proposed a revision of the survey during the face-to-face interview, and most of these suggestions were retained.


A valid multi-step process leads to the creation of the final version of the VHNSS-IT, a suitable instrument to screen for symptoms in the Italian HNC patients population and an official measurement tool that can be used in cooperative research group.


Patient reported outcomes (PRO) Head and neck cancer Symptoms screening Radiotherapy 



All authors gratefully thank the 10-member team of reviewers for their precious help: Prof. A. Deganello and Dr. A. Paderno from the Department of Otorhinolaryngology—Head and Neck Surgery, University of Brescia, Brescia, Italy; Prof. P. Bossi and Dr. S. Grisanti from the Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili, Brescia, Italy; Prof. F. Paiar from the Department of Radiation Oncology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy; Dr. D. Alterio from the Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy; Dr. L. Belgioia from the Radiation Oncology Department IRCCS San Martino Hospital and Health Science Department (DISSAL) University of Genoa, Genoa, Italy; Dr. M. Andreoli and R. Bertoli (dietician) from the Dietetics and Clinical Nutrition Unit, ASST Spedali Civili, Brescia, Italy; C. Cominardi (nurse) from the Department of Radiation Oncology, ASST Spedali Civili, Brescia, Italy.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Research involving human participants and/or animals: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Marta Maddalo
    • 1
    Email author
  • Michela Buglione
    • 1
  • Nadia Pasinetti
    • 2
  • Luca Triggiani
    • 1
  • Loredana Costa
    • 1
  • Stefano M. Magrini
    • 1
  • Barbara A. Murphy
    • 3
  1. 1.Department of Radiation OncologyASST Spedali Civili di Brescia - Brescia UniversityBresciaItaly
  2. 2.Department of Radiation OncologyOspedale di Esine – ASL Vallecamonica-SebinoEsineItaly
  3. 3.Department of MedicineVanderbilt University Medical CenterNashvilleUSA

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