Real-world evaluation of the christie symptom inventory-lung cancer (CSI-lung) electronic patient-reported outcome measure: validity, reliability, responsiveness, and patient experiences

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OBJECTIVES: The routine use of electronic patient-reported outcome measures (ePROMs) in oncology is expanding internationally, yet uncertainty remains regarding the most suitable tool for routine care. The Christie Symptom Inventory-Lung Cancer (CSI-Lung) was developed for routine care. This study evaluated its content validity, psychometric performance using real-world data, and patient experience. MATERIALS AND METHODS: A mixed-methods evaluation, guided by COSMIN methodology, was conducted. Content validity was assessed through cognitive interviews with nine patients, examining item relevance, comprehensibility, and comprehensiveness. Quantitative analyses used routinely collected ePROM data from 2,483 patients with lung cancer. Test-retest reliability was assessed using quadratic-weighted Cohen's kappa, with stable health defined using EQ-5D-5L and EQ-VAS. Construct validity was evaluated using Spearman correlations with EQ-5D-5L (convergent validity) and comparisons across ECOG performance status (known-groups validity). Responsiveness was assessed using Kendall's tau between symptom changes and EQ-VAS changes. Patients experience was evaluated through surveys completed by 274 patients. RESULTS: Interviews demonstrated high relevance and comprehensibility. Test-retest reliability showed weighted kappa > 0.7 for 10/14 items, with over 80% agreement across items. All items expectedly correlated negatively with EQ-5D-5L, particularly tiredness, pain, and breathlessness. Known-group validity was supported, with worse symptoms in patients with poorer performance status. Responsiveness analyses showed expected negative correlations with EQ-VAS. Patient experience was positive: 93% found CSI-Lung easy to complete, 92% clinically useful, and 89% supportive of care. CONCLUSION: CSI-Lung demonstrated measurement properties consistent with clinical expectations and high patient acceptability, supporting its use in routine care and further validation across diverse settings and populations.

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