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Patient-reported outcomes (PROs) provide essential insights into the lived experience of patients with chronic diseases. Specifically, using the NFOSI-18 in ovarian cancer clinical trials allows for a structured evaluation of symptom burden. In recurrent ovarian cancer, quality of life often dictates the choice between aggressive and palliative treatment. Consequently, clinicians need validated tools to measure these subjective experiences accurately. The recent GY004 phase III study addressed this need by conducting a psychometric evaluation of the NCCN/FACT Ovarian Symptom Index-18.
The research team analyzed data from 489 participants who completed the NFOSI-18 and EQ-5D-3L assessments. Reliability scores for the total scale and physical subscales were strong. For instance, Cronbach's alpha values ranged from 0.72 to 0.87. Furthermore, the tool demonstrated moderate convergent validity when compared with the EQ-5D Utility Index. The study also observed strong known-groups validity. Patients with better performance status consistently showed higher scores than those with impaired status. Thus, the tool effectively differentiates between distinct clinical populations.
Clinical utility depends on a tool's responsiveness to changes in disease status. The study found that score declines were significantly greater in patients with progressive disease. Conversely, those with complete or partial responses maintained more stable scores. This finding confirms that the tool accurately reflects clinically meaningful change. Additionally, the researchers established recommended change thresholds to guide future research. For the total NFOSI-18 score, a change of 4 to 12 points is considered meaningful. Similarly, the disease-related symptoms-physical (DRS-P) subscale requires a 3 to 8 point change.
Ultimately, these results support the routine use of NFOSI-18 as a primary endpoint in clinical research. By using a validated measure, oncologists can better understand the physical and emotional impact of targeted therapies. Moreover, such data can lead to more personalized care plans that prioritize patient well-being alongside survival metrics. The validation of this index ensures that the patient's voice remains a central part of the therapeutic decision-making process.
The NFOSI-18 is an 18-item symptom index specifically designed for ovarian cancer. It assesses disease-related symptoms, treatment side effects, and overall functional well-being from the patient's perspective.
For the total score, a change between 4 and 12 points indicates a clinically meaningful difference. For the disease-related symptoms-physical (DRS-P) subscale, the threshold is between 3 and 8 points.
Disclaimer: This content is for informational and educational purposes only... Refer to the latest local and national guidelines for clinical practice.
References
Tang X et al. Psychometric evaluation of the NFOSI-18 disease related symptoms - Physical, NFOSI-18 Total, and FACT GP5 in the recurrent ovarian cancer phase III study GY004. Gynecol Oncol. 2026 Jun 08. doi: undefined. PMID: 42258989.
Trigg J et al. Reliability, validity and important difference estimates for the NCCN-FACT Ovarian Symptom Index-18 (NFOSI-18). Health Qual Life Outcomes. 2021 Jul 21. doi: 10.1186/s12955-021-01822-4. PMID: 34290076.
Jensen SE et al. Further content validation of the 18-item NCCN/FACT Ovarian Symptom Index and its Disease Related Symptom-Physical (DRS-P) subscale for use in advanced ovarian cancer clinical trials. Gynecol Oncol. 2019 Dec 19. doi: 10.1016/j.ygyno.2019.10.024. PMID: 31735399.
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A psychometric evaluation of the NFOSI-18 tool in the GY004 study confirms its reliability and validity for assessing symptoms in recurrent ovarian cancer....
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