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Most (81%) considered the items \u201cI have pain\u201d and \u201cI have cramps in my stomach area\u201d to be more different than similar. Participants associated \u2018fatigue\u2019 with intense tiredness and \u2018lack of energy\u2019 with motivation and capability to complete daily activities. Item comparisons revealed a majority (65%) considered the items to be more different than similar. When responding to \u201cI am bothered by constipation,\u201d patients indicated constipation severity was related to bother. Finally, patients considered disease, treatment, and other factors when responding to \u201cI am sleeping well.\u201d<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Findings support content validity of the NFOSI-18 and its DRS-P as originally constructed. We propose an alternative scoring option that excludes the item \u201cI am sleeping well\u201d from the DRS-P when used as a symptom-focused index for clinical research in a regulatory context.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12955-019-1253-3","type":"journal-article","created":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T09:04:20Z","timestamp":1576746260000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["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"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2878-7223","authenticated-orcid":false,"given":"Sara","family":"Shaunfield","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sally","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison P.","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Webster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shohreh","family":"Shahabi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arijit","family":"Ganguli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Cella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,12,19]]},"reference":[{"key":"1253_CR1","unstructured":"American Cancer Society. 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SJ and APF have no competing interests disclose; KW received research funding from AbbVie and is the spouse of  and FACIT.Trans\u2019 President; SS<sup>2<\/sup> received a grant from AbbVie outside the submitted work; AG is a full-time employee of AbbVie and may own AbbVie stock or stock options; DC serves as a consultant to AbbVie, BMS, Pfizer, and AstraZeneca outside the submitted work, is President of  and FACIT.Trans, and received research funding from AbbVie, Pfizer, and Clovis.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"185"}}