therefore, with better quality of life. When our FACT-L results are compared with those from other studies using the same questionnaire, we find that there is great variability between countries and different cul- tures,2,3,7,22,24–27 which may be due to differing perceptions of the questions according to each culture and also differences in patient characteristics, such as staging, age, socioeconomic status, among others. The FLSI is an index designed to identify the presence of the major symptoms related to lung cancer, including dyspnea, pain, fatigue, cough, and weight loss.28 These symptoms can negatively influence quality of life. In this study, in addition to the medical evaluation, FLSI was also used to assess the patient’s clinical stability. The reliability for all scores of the FACT-L showed ICC values greater than 0.75, ranging from 0.78 (SWB) to 0.96 (FACT-L TOI). These values show excellent reliability and are similar to those found in other studies. In the validation study of the Korean version of the FACT-L,25 the ICC ranged from 0.52 to 0.84. The Chinese version3 varied from 0.76 to 0.82. In the reliability study of the original version, the ICC ranged from 0.56 (SWB) to 0.89 (FACT-L TOI).7 The FLSI also showed high reliability, which confirms the stability of the sample. Most of the FACT-L questions showed adequate reliability, analyzed by the kappa coeffi- cient. In this study, the reliability analyses were conducted with a convenience sample similar to other studies evaluating the reliability and cultural adaptation of other questionnaires to the Portuguese language.12–15 In our sample, males predominated, in agreement with the worldwide prevalence of lung cancer.1 The mean age was 61.3 years, which is consistent with most studies that include patients with lung cancer.1,5 Regarding histological type, adenocarcinoma was the most prevalent, consistent with several epidemiological studies in developed coun- tries.1 Unfortunately, regarding staging, there was a predominance of stage III and IV, stages with less chance of survival after treatment.29 The mean FEV1 (% predicted) and FEV1/FVC ratio in our study were similar to the results reported by Young et al., who observed a FEV1 (% predicted) mean of 73% and FEV1/FVC mean of 64% in smokers with lung cancer.30 In our study, there was no correlation between the questionnaire and the analyzed lung function parameters, consistent with other studies that found no significant correlation when investigating the effects of altered pulmonary function on the quality of life of cancer patients.31,32 The process of translating the FACT-L questionnaire and FLSI into the Portuguese language (Brazil) was performed by the FACIT group. Only a few doubts were reported by the patients, which warrants its use in the current form. Few patients had difficulty in interpreting the word ‘‘muit´ıssimo’’; however, many of the patients interviewed understood the meaning of the term not because it is a familiar word, but because they realized that it was a scale with a progressive score in which the numerical value assigned to the word ‘‘muit´ıssimo’’ yielded the highest score. The suggested changes were sent to the FACIT group. Alterations to this tool were proposed only for question Q1 ‘‘Independentemente do seu n´ıvel a(c)tual de a(c)tivi- dade sexual, favor de responder a` pergunta a seguir. Se preferir na˜o responder, assinale o quadr´ıculo % e passe para a pro´ xima sec¸a˜o’’. Despite not raising doubts, the 1250 CLINICS 2010;65(12):1247-1251 words ‘‘atual’’ and ‘‘atividade’’ do not require the letter ‘‘(c)’’, and there is no need to use the preposition ‘‘de’’ after the word ‘‘favor’’, both grammatical constructions used in the Portuguese language in Portugal. We conclude that the Brazilian version of the FACT-L questionnaire and FLSI is reproducible, fast, and of simple application, and that they are capable of measuring the quality of life in lung cancer patients in Brazil. REFERENCES 1. Landi MT, Consonni D, Rotunno M, Bergen AW, Goldstein AM, Lubin JH, et al. Environment and Genetics in Lung cancer Etiology (EAGLE) study: an integrative population-based case-control study of lung cancer. BMC Public Health. 2008;8:203, doi: 10.1186/1471-2458-8-203. 2. Browning KK, Ferketich AK, Otterson GA, Reynolds NR, Wewers ME. A psychometric analysis of quality of life tools in lung cancer patients who smoke. Lung Cancer. 2009;66:134–9, doi: 10.1016/j.lungcan.2008.12.018. 3. Wan C, Zhang C, Cai L, Tu X, Feng C, Luo J, et al. Psychometric properties of the Chinese version of the FACT-L for measuring quality of life in patients with lung cancer. Lung Cancer. 2007;56: 415–21, doi: 10. 1016/j.lungcan.2007.01.004. 4. Brasil. Ministe´rio da Sau´ de. Instituto Nacional de Caˆncer I. Estimativa 2010: Incideˆncia de Caˆncer no Brasil. Rio de Janeiro: INCA; 2009. 5. Franceschini J, Santos AA, El Mouallem I, Jamnik S, Uehara C, Fernandes AL, et al. [Assessment of the quality of life of patients with lung cancer using the Medical Outcomes Study 36-item Short-Form Health Survey]. J Bras Pneumol. 2008;34:387–93, doi: 10.1590/S1806-37132008000600009. 6. Butt Z, Webster K, Eisenstein AR, Beaumont J, Eton D, Masters GA, et al. Quality of life in lung cancer: the validity and cross-cultural applicability of the Functional Assessment of Cancer Therapy-Lung scale. Hematol Oncol Clin North Am. 2005;19:389–420, viii, doi: 10.1016/j.hoc.2005.02. 009. 7. Cella DF, Bonomi AE, Lloyd SR, Tulsky DS, Kaplan E, Bonomi P. Reliability and validity of the Functional Assessment of Cancer Therapy- Lung (FACT-L) quality of life instrument. Lung Cancer. 1995;12:199–220, doi: 10.1016/0169-5002(95)00450-F. 8. Montazeri A, Gillis CR, McEwen J. Quality of life in patients with lung cancer: a review of literature from 1970 to 1995. Chest. 1998;113:467–81, doi: 10.1378/chest.113.2.467. 9. Webster K, Cella D, Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes. 2003; 1:79, doi: 10.1186/ 1477-7525-1-79. 10. Folstein MF, Folstein SE, McHugh PR. ‘‘Mini-mental state’’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98, doi: 10.1016/0022-3956(75)90026-6. 11. Almeida OP. [Mini mental state examination and the diagnosis of dementia in Brazil]. Arq Neuropsiquiatr. 1998;56:605–12. 12. Camelier A, Rosa FW, Salim C, Nascimento OA, Cardoso F, Jardim JR. Using the Saint George’s Respiratory Questionnaire to evaluate quality of life in patients with chronic obstructive pulmonary disease: validating a new version for use in Brazil. J Bras Pneumol. 2006;32:114–22, doi: 10. 1590/S1806-37132006000200006. 13. Carpes MF, Mayer AF, Simon KM, Jardim JR, Garrod R. The Brazilian Portuguese version of the London Chest Activity of Daily Living scale for use in patients with chronic obstructive pulmonary disease. J Bras Pneumol. 2008;34:143–51, doi: 10.1590/S1806-37132008000300004. 14. Sousa T, Jardim J, Jones P. Validac¸a˜o do Questiona´rio do Hospital Saint George na Doenc¸a Respirato´ria (SGRQ) em pacientes portadores de doenc¸a pulmonar obstrutiva croˆnica no Brasil. J Pneumol. 2000;26:119–28. 15. Kovelis D, Segretti NO, Probst VS, Lareau SC, Brunetto AF, Pitta F. Validation of the Modified Pulmonary Functional Status and Dyspnea Questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease. J Bras Pneumol. 2008;34:1008–18. 16. Uehara C, Santoro I, Ferreira R. Caˆncer de pulma˜o: diagno´stico e estadiamento. In: Nery L, Fernandes A, Perfeito J, eds. Pneumologia. Barueri: Manole; 2006. p. 495–509. 17. Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest. 1997;111:1710–17, doi: 10.1378/chest.111.6.1710. 18. Karnofsky DA, Golbey RB, Pool JL. Preliminary studies on the natural history of lung cancer. Radiology. 1957;69:477–88. 19. Pereira C. Espirometria. J Pneumol. 2002;28(Suppl. 3):S1–S82. 20. Arnold BJ, Eremenco E, Chang C-H, Odom L, Ribaudo JM, Cella D. Development of a single Portuguese language version of the Functional Assessment of Cancer Therapy - General (FACT-G) Scale. Qual Life Res. 2000;9:316. 21. Arnold BJ, Eremenco S, Chang CH, Cella D, Riberiro JLP, Doro MP et al. How much is ‘‘very much’’? Developing a rating scale for Portuguese speaking countries. Qual Life Res. 2001; 10:264.