A randomized validation study comparing embedded versus extracted FACT Head and Neck Symptom Index scores

Susan Yount, Marcy List, Hongyan Du, Kathleen Yost, Rita Bode, Bruce Brockstein, Athanassios Argiris, Everett Vokes, Ezra E.W. Cohen, Bruce Campbell, Veronica Valenzuela, Jacquelyn George, Robyn Egan, Jessica Chen, David Meddis, David Cella

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: To evaluate the impact of administration context (embedded versus stand-alone) on the reliability and validity of the FACT Head and Neck Symptom Index (FHNSI). Methods: Ninety-eight patients with head and neck cancer were randomized to one of two assessment conditions to evaluate the FHNSI's context (items administered embedded within the FACT-H&N or as stand-alone scale) and order of administration in the battery. Results: Planned comparisons on the item and scale levels revealed no systematic order or context differences. The embedded and stand-alone versions of the FHNSI showed high internal consistency (Cronbach's alpha 0.79-0.87). Correlations were high between the FHNSI versions and the physical and functional well-being scales of the FACT-H&N (0.70-0.84) and measures of pain intensity (-0.73, -0.74) and depression (-0.71, -0.74); moderate to large with the Performance Status Scale for Head and Neck subscales (PSS-HN; 0.46-0.71); and low with an anxiety measure (0.30, 0.34). Both FHNSI versions differentiated patients grouped by performance status (p < .0001, p < .0001) and global rating of change (p < .0001, p < 0.01). The FHNSI's minimally important difference range was 3-4 points. Conclusion: The FHNSI is a reliable and valid symptom index, which can be administered alone or scored using items embedded within the FACT-H&N.

Original languageEnglish (US)
Pages (from-to)1615-1626
Number of pages12
JournalQuality of Life Research
Issue number10
StatePublished - Dec 2007
Externally publishedYes


  • Head and neck cancer
  • Measurement issues
  • Signs & symptoms

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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