The Childhood Cancer Survivor Study–Neurocognitive Questionnaire (CCSS-NCQ) Revised: Item Response Analysis and Concurrent Validity

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Childhood cancer survivors are at risk for neurocognitive impairment related to cancer diagnosis or treatment. This study refined and further validated the Childhood Cancer Survivor Study–Neurocognitive Questionnaire (CCSS-NCQ; Krull et al., 2008), a scale developed to screen for impairment in long-term survivors of childhood cancer.


Items related to task efficiency, memory, organization, and emotional-regulation domains were examined using item response theory (IRT). Data were collected from 833 adult survivors of childhood cancer who completed self-report and direct neurocognitive testing for the St. Jude Lifetime Cohort Study. The revision process included: (a) content-validity mapping of items to domains, (b) constructing a revised CCSS-NCQ, (c) selecting items within specific domains using IRT, and (d) evaluating concordance between the revised CCSS-NCQ and direct neurocognitive assessment.


Using content and measurement properties, 32 items were retained (8 items in 4 domains). Items captured low to middle levels of neurocognitive concerns. The latent domain scores demonstrated poor convergent/divergent validity with the direct assessments. Adjusted ESs (ES; Cohen's d) for agreement between self-reported memory and direct memory assessment were moderate for total recall (ES = 0.66), long-term memory (ES = 0.63), and short-term memory (STM; ES = 0.55). ESs between self-rated task efficiency and direct assessment of attention were moderate for focused attention (ES = 0.70) and attention span (ES = 0.50), but small for sustained attention (ES = 0.36). Cranial radiation therapy and female gender were associated with lower self-reported neurocognitive function.


The revised CCSS-NCQ demonstrates adequate measurement properties for assessing day-to-day neurocognitive concerns in childhood cancer survivors, and adds useful information to direct assessment.

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