Supportive Care in Cancer

, Volume 26, Issue 7, pp 2229–2238 | Cite as

Content validity and electronic PRO (ePRO) usability of the Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) in mesothelioma patients

  • Heather L. GelhornEmail author
  • Anne M. Skalicky
  • Zaneta Balantac
  • Sonya Eremenco
  • Tricia Cimms
  • Katarina Halling
  • Patricia J. Hollen
  • Richard J. Gralla
  • Martin C. Mahoney
  • Chris Sexton
Original Article



Obtaining qualitative data directly from the patient perspective enhances the content validity of patient-reported outcome (PRO) instruments. The objective of this qualitative study was to evaluate the content validity of the Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso) and its usability on an electronic device.


A cross-sectional methodological study, using a qualitative approach, was conducted among patients recruited from four clinical sites. The primary target population included patients with pleural mesothelioma; data were also collected from patients with peritoneal mesothelioma on an exploratory basis. Semi-structured interviews were conducted consisting of concept elicitation, cognitive interviewing, and evaluation of electronic patient-reported outcome (ePRO) usability.


Participants (n = 21) were interviewed in person (n = 9) or by telephone (n = 12); 71% were male with a mean age of 69 years (SD = 14). The most common signs and symptoms experienced by participants with pleural mesothelioma (n = 18) were shortness of breath, fluid build-up, pain, fatigue, coughing, and appetite loss. The most commonly described symptoms for those with peritoneal mesothelioma (n = 4) were bloating, changes in appetite, fatigue, fluid build-up, shortness of breath, and pain. Participants with pleural mesothelioma commonly described symptoms assessed by the LCSS-Meso in language consistent with the questionnaire and a majority understood and easily completed each of the items. The ePRO version was easy to use, and there was no evidence that the electronic formatting changed the way participants responded to the questions.


Results support the content validity of the LCSS-Meso and the usability of the electronic format for use in assessing symptoms among patients with pleural mesothelioma.


Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso) HRQL Patient-reported outcome Symptoms 



The authors thank Katelyn Cutts for her assistance during the study and Fritz Hamme, Janet Pooley, and Amara Tiebout for editorial and production assistance. Lastly, the authors thank the staff at the clinical sites and the patients who participated in this study.


Funding for this research and manuscript was provided by AstraZeneca.

Compliance with ethical standards

Conflict of interest

Dr. Halling is currently employeed and Ms. Cimms formerly employed by AstraZeneca. Dr. Gelhorn and Ms. Skalicky are current salaried employees, and Ms. Eremenco and Dr. Sexton are former employees of Evidera, a consulting company that has received funding from AZ for conducting the study. Dr. Mahoney’s institution received payment for participating in the research study. The authors have no other relevant affiliations or financial involvement with any organization or entity with financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethical approval

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.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Heather L. Gelhorn
    • 1
    Email author
  • Anne M. Skalicky
    • 1
  • Zaneta Balantac
    • 1
  • Sonya Eremenco
    • 1
  • Tricia Cimms
    • 2
  • Katarina Halling
    • 3
  • Patricia J. Hollen
    • 4
  • Richard J. Gralla
    • 5
  • Martin C. Mahoney
    • 6
  • Chris Sexton
    • 1
  1. 1.EvideraBethesdaUSA
  2. 2.AstraZenecaGaithersburgUSA
  3. 3.AstraZenecaGothenburgSweden
  4. 4.University of VirginiaCharlottesvilleUSA
  5. 5.Albert Einstein College of MedicineBronxUSA
  6. 6.Roswell Park Cancer InstituteBuffaloUSA

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