Brief Methodological Report| Volume 61, ISSUE 3, P571-578.e1, March 2021

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings



      The Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest.


      To crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer.


      A cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested.


      The CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74–0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33–0.36, respectively).


      The study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.

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        • Parshall M.B.
        • Schwartzstein R.M.
        • Adams L.
        • et al.
        An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea.
        Am J Respir Crit Care Med. 2012; 185: 435-452
        • Currow D.C.
        • Clark K.
        • Mitchell G.K.
        • Johnson M.J.
        • Abernethy A.P.
        Prospectively collected characteristics of adult patients, their consultations and outcomes as they report breathlessness when presenting to general practice in Australia.
        PLoS One. 2013; 8: e74814
        • Currow D.C.
        • Plummer J.L.
        • Crockett A.
        • Abernethy A.P.
        A community population survey of prevalence and severity of dyspnea in adults.
        J Pain Symptom Manage. 2009; 38: 533-545
        • Solano J.P.
        • Gomes B.
        • Higginson I.J.
        A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease.
        J Pain Symptom Manage. 2006; 31: 58-69
        • Bruera E.
        • Schmitz B.
        • Pither J.
        • Neumann C.M.
        • Hanson J.
        The frequency and correlates of dyspnea in patients with advanced cancer.
        J Pain Symptom Manage. 2000; 19: 357-362
        • Escalante C.P.
        • Martin C.G.
        • Elting L.S.
        • et al.
        Identifying risk factors for imminent death in cancer patients with acute dyspnea.
        J Pain Symptom Manage. 2000; 20: 318-325
        • Currow D.C.
        • Smith J.
        • Davidson P.M.
        • et al.
        Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study.
        J Pain Symptom Manage. 2010; 39: 680-690
        • Gupta D.
        • Lis C.G.
        • Grutsch J.F.
        The relationship between dyspnea and patient satisfaction with quality of life in advanced cancer.
        Support Care Cancer. 2007; 15: 533-538
        • Bausewein C.
        • Booth S.
        • Gysels M.
        • et al.
        Individual breathlessness trajectories do not match summary trajectories in advanced cancer and chronic obstructive pulmonary disease: results from a longitudinal study.
        Palliat Med. 2010; 24: 777-786
        • Tanaka K.
        • Akechi T.
        • Okuyama T.
        • Nishiwaki Y.
        • Uchitomi Y.
        Development and validation of the Cancer Dyspnoea Scale: a multidimensional, brief, self-rating scale.
        Br J Cancer. 2000; 82: 800-805
        • Uronis H.E.
        • Shelby R.A.
        • Currow D.C.
        • et al.
        Assessment of the psychometric properties of an English version of the cancer dyspnea scale in people with advanced lung cancer.
        J Pain Symptom Manage. 2012; 44: 741-749
        • Henoch I.
        • Bergman B.
        • Gaston-Johansson F.
        Validation of a Swedish version of the cancer dyspnea scale.
        J Pain Symptom Manage. 2006; 31: 353-361
        • Damani A.
        • Ghoshal A.
        • Salins N.
        • Deodhar J.
        • Muckaden M.
        Validation of “cancer dyspnea scale” in patients with advanced cancer in a palliative care setting in India.
        J Pain Symptom Manage. 2017; 54: 715-720.e1
        • Beaton D.E.
        • Bombardier C.
        • Guillemin F.
        • Bosi Ferraz M.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        SPINE. 2000; 25: 3186-3191
        • Lawshe C.
        A quantitative approach to content validity.
        Pers Psychol. 1975; 28: 563-575
        • Lynn M.
        Determination and quantification of content validity.
        Nurs Res. 1986; 35: 382-385
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-Mental State”: a practical guide for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Karnofsky D.A.
        • Burchenal J.H.
        The clinical evaluation of chemotherapeutic agents in cancer.
        in: MacLeod C.M. Evaluatio of Chemotherapeutic Agents in Cancer. Columbia University Press, New York1949: 191-205
        • Crooks V.
        • Waller S.
        • Smith T.
        • Hahn T.J.
        The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients.
        J Gerontol. 1991; 46: M139-M144
        • Mor V.
        • Laliberte L.
        • Morris J.N.
        • Wiemann M.
        The Karnofsky performance status scale. An examination its reliability validity a research setting.
        Cancer. 1984; 53: 2002-2007
        • Schag C.C.
        • Heinrich R.L.
        • Ganz P.A.
        Karnofsky performance statu revisited: reliability, validity, and guidelines.
        J Clin Oncol. 1984; 2: 187-193
        • Gift A.G.
        Validation of a vertical visual analogue scale as a measure of clinical dyspnea.
        Rehabil Nurs. 1989; 14: 323-325
        • Hu J.
        • Meek P.
        Health-related quality of life in individuals with chronic obstructive pulmonary disease.
        Heart Lung. 2005; 34: 415-422
        • Tusman G.
        • Bohm S.H.
        • Suarez-Sipmann F.
        Advanced uses of pulse oximetry for monitoring mechanically ventilated patients.
        Anesth Analg. 2017; 124: 62-71
        • Groenvold M.
        • Petersen M.A.
        • Aaronson N.K.
        • et al.
        The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care.
        Eur J Cancer. 2006; 42: 55-64
        • Lien K.
        • Zeng L.
        • Nguyen J.
        • et al.
        Comparison of the EORTC QLQ-C15-PAL and the FACIT-Pal for assessment of quality of life in patients with advanced cancer.
        Expert Rev Pharmacoecon Outcomes Res. 2011; 11: 541-547
        • Nunes N.A.
        The quality of life of Brazilian patients in palliative care: validation of the European organization for research and treatment of cancer quality of life questionnaire core 15 PAL (EORTC QLQ-C15-PAL).
        Support Care Cancer. 2014; 22: 1595-1600
        • Bausewein C.
        • Fegg M.
        • Radbruch L.
        • et al.
        Validation and clinical application of the German version of the palliative care outcome scale.
        J Pain Symptom Manage. 2005; 30: 51-62
        • Higginson I.J.
        • Simon S.T.
        • Benalia H.
        • et al.
        Which questions of two commonly used multidimensional palliative care patient reported outcome measures are most useful? Results from the European and African PRISMA survey.
        Postgrad Med J. 2012; 88: 451-457
        • Hearn J.
        • Higginson I.J.
        Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group.
        Qual Health Care. 1999; 8: 219-227
        • Bausewein C.
        • Le Grice C.
        • Simon S.
        • Higginson I.
        PRISMA. The use of two common palliative outcome measures in clinical care and research: a systematic review of POS and STAS.
        Palliat Med. 2011; 25: 304-313
      1. Palliative Care outcome Scale. A resource for palliative care.
        (Available from)
        Date accessed: January 26, 2016
        • Mokkink L.B.
        • Prinsen C.A.
        • Patrick D.L.
        • et al.
        COSMIN methodology for systematic reviews of Patient-Reported Outcome Measures (PROMs); user manual.
        (Available from)
        Date: 2017
        Date accessed: August 3, 2018
        • Bausewein C.
        • Farquhar M.
        • Booth S.
        • Gysels M.
        • Higginson I.J.
        Measurement of breathlessness in advanced disease: a systematic review.
        Respir Med. 2007; 101: 399-410
        • Dorman S.
        • Byrne A.
        • Edwards A.
        Which measurement scales should we use to measure breathlessness in palliative care? A systematic review.
        Palliat Med. 2007; 21: 177-191