Quality of Life in Patients With Lung Cancer: InstrumentsOver 50 instruments were used to measure quality of life or some dimensions of life quality in patients with lung cancer (Table 1). Some of these instruments were used rarely, some were used only for validation purposes, and some were not true quality of life measures. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C-36 or C-30), the Rotterdam Symptom Checklist (RSCL), the Hospital Anxiety and Depression Scale (HADS), the Functional Living Index-Cancer (FLI-C), and the Daily Diary Card (DDC) were among the most popular instruments used, and their applications in studies of quality of life are well documented. Virus Bronchiolitis
The DDC is one of the widely used instruments in the UK context. The instrument was developed by the Medical Research Council Lung Cancer Working Party and has been used in many randomized trials. Although its sensitivity is well documented, it has been criticized because compliance with DDC is low, and it has a limited focus on treatment-related side effects.
There were three site-specific (lung cancer) measures: the Lung Cancer Symptom Scale (LCSS), the Functional Assessment of Cancer Therapy-Lung (FACT-L), and the EORTC QLQ LC-13.
The LCSS focuses on the physical and functional dimensions of quality of life, measuring major lung cancer symptoms and their effect on activity status. It consists of two instruments: one for patients and one for health professionals as observers. The patient scale consist of nine items: six measuring major symptoms for lung cancer (loss of appetite, fatigue, cough, dyspnea, hemoptysis, and pain) and three summation items related to total symptomatic distress, activity status, and overall quality of life all using visual analog scale. The observer scale is a five-point ordinal level scale similar in content to the patient scale measuring the intensity of six major lung cancer symptoms.
The LCSS is a very limited measure of quality of life because it does not contain many of the important components of the quality of life and in addition, its introductory statement contains the word “lung cancer,” which might be seen as a limiting factor.
The FACT-L (version 3) is a 44-item self-reported instrument and consists of two parts. Part 1 is a 34-item measure of general health-related quality of life covering five dimensions; physical, social and family, emotional, and functional well-being, and relationship with physician. Part 2 (Lung Cancer Subscale) is a 10-item measure of quality of life with emphasis on lung cancer symptoms.
Table 1—Selected Quality of Life Measures Used in Lung Cancer Studies

Instruments Items Dimensions
1. Performance status
KPS 11 Performance status
ECOG performance status scale 5 Performance status
2. Generic measures
SIP 136 Physical and psychological status, sleep and rest, work, home management, recreation and pasttimes
3. Psychological
Profile of Mood States (POMS) 65 Tension, depression, anger, vigor, fatigue, confusion
HADS 14 Anxiety, depression
Symptom Checklist-90 90 Nine subscales: depression, anxiety, somatization, obsessive-compulsive, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, and psychotics
4. Cancer specific
DDC 5 Overall condition, physical activity, vomiting, mood, anxiety
FLI-C 22 Physical symptoms, mood, physical activity, work, social interaction; it is a VAS
RSCL 38 Physical, psychological, and functional status
Symptom Distress Scale 13 Cancer symptoms (appetite, nausea, sleep, elimination, pain, fatigue, breathing, cough, outlook, appearance, concentration)
EORTC QOL-C36 or QOL-C30 36 Functioning (physical, role, emotional, social), cancer symptoms, financial impact, physical symptoms, overall health, and quality of life
5. Site specific
EORTC QOL-LC13 44 EORTC core questionnaire plus lung cancer-related symptoms and treatment side-effects (30 core items+13-item lung cancer specific)
LCSS 15 Lung cancer-related symptoms (patient and observer rated)
FACT-L 44 Physical well-being, social/family well-being, relationship with physician, emotional well-being, functional well-being, lung cancer symptoms (34 items general and 10 specific)