Comments on: ‘Social Issues and Emotional Distress amongst Cancer Patients – Measurement Concerns’

Dear Editor, I read with great interest the article by Rohini et al. examining social issues and emotional distress amongst patients with cancer receiving palliative care in a tertiary cancer centre [1] and congratulate the authors on their important contribution.Their report of a 94.1% prevalence of moderate-to-severe distress, measured using the validated National Comprehensive Cancer Network (NCCN) Distress Thermometer, provides valuable data on the psychological burden experienced by palliative care patients in India.I wish to draw attention to a potential reporting concern regarding the Social Issues Rating Scale developed and used in this study.The paper states Cronbach's alpha as '>0.07' .Conventionally, a Cronbach's alpha value of ≥0.70 is considered indicative of acceptable internal consistency, [2] and the reported figure falls considerably below this standard.It is quite possible that '>0.07' represents a typographical error, with the intended value being '>0.70' .If this represents a typographical error, publication of an erratum or correction would help avoid potential misunderstanding.However, if the reported value is accurate, it would indicate limited internal consistency amongst the 16-item scale, and the authors may wish to clarify this by providing the correct value or, if appropriate, further information regarding the psychometric evaluation of the scale.It is important to note that the overall distress prevalence of 94.1% was derived from the NCCN Distress Thermometer, which has been validated in Malayalam and has demonstrated high face validity and feasibility in Kerala.[3] Concerns regarding the Social Issues Rating Scale therefore do not directly affect the distress prevalence estimate.However, they may influence the interpretation of the social domain sub-scores, particularly the identification and characterisation of individual social stressors such as family role change, financial crisis, social isolation and dependency.Caution in interpretation would be appropriate pending clarification of the scale's psychometric properties.