The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): Validation Study of the Thai Version

Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: "Pallium Game"

Communication between the multidisciplinary team, the person, and the family in palliative and end-of-life situations implies, in most situations, a high negative emotional burden. Therefore, innovative strategies are needed to reduce it. The goal of this study is to describe the various stages of development and validation of a collaborative card game for people in palliative care and their families. Phase one is an exploratory study, Phase two is a Delphi study, and Phase three is a multiple case study. Participants for phases 2 and 3 were recruited using a convenience sampling method. The results demonstrate in an organized and structured way the different phases required to build a collaborative card game. The use of the game was found to be useful and effective. Four categories emerged from the content analysis of the open-ended responses: usability, evaluation tool, communication and therapeutic relationship, and meaning when using the game. A collaborative game in palliative care helps to create a space for individuals and families to express feelings and experiences, meeting the myriad of physical, psychosocial, and spiritual needs. The "Pallium game" is a useful and impactful approach to discussing sensitive topics in palliative care.

Validation of Gujarati Version of European Organization for Research and Treatment of Cancer Quality of Life Modules in Head and Neck Cancer Patients of Western India

Head and neck cancer and its treatment had a significant impact on the quality of life. EORTC QLQ-C30 and EORTC QLQ-H&N35 are the two most widely used modules to assess the quality of life among head and neck cancer patients. The aim of the study is to test the reliability and validity of Gujarati version of EORTC QLQ-C30 and QLQ-H&N35module in a clinical setting. Gujarati version of EORTC QLQ-C30 and QLQ-H&N35 was administered to 400 histo-pathologically proven cases of head and neck cancer. For testing the internal consistency (reliability) Cronbach's alpha coefficient was used. The convergent and discriminant validity were explored by using Spearman's correlation coefficient test. Factor analysis was performed to obtain information about loading of the items for each scale. All most all scales of EORTC QLQ-C30 and QLQ-H&N35 showed high internal consistency having Cronbach's alpha coefficient > 0.70. Spearman's correlation coefficient ranges from -0.45 to 0.95 for EORTC QLQ-C30 and 0.42-0.94 for EORTC QLQ-H&N35 showing moderate to good convergent validity. The magnitude of the correlation of each item with its own scale exceeded the correlation with another scale confirming item discriminant validity. The factor analysis resulted in 7 and 11 different components for measuring quality of life for EORTC QLQ-C30 and QLQ-H&N35 respectively. Based on the results obtained it can be concluded that the Gujarati version of both the modules is a reliable and valid tool for measuring quality of life in head and neck cancer patients in clinical settings.

Effect of hospital-based case management on psychosocial wellbeing and treatment outcomes in colorectal cancer patients: A quasi-experimental study

BACKGROUND

Case management has been regarded as the front line of necessary change for fragmented healthcare system.

AIM

This study proposed a case management intervention that is suitable for Chinese colorectal cancer patients and explored its effectiveness over a 12-month follow-up.

METHODS

A quasi-experimental study was conducted in an oncology hospital in China. A total of 188 patients were recruited from May 2015 to February 2017; 85 patients in the control group and 80 patients in the intervention group were included in data analysis. The intervention group was managed for 1 year by a case manager who organized the multidisciplinary team, provided regular assessment, a consulting service and referrals. Quality of life, anxiety and depression, symptom distress, treatment adherence and unplanned readmission rates were measured.

RESULTS

Repeated measurement ANOVA showed significant intervention and time effects in global quality of life, anxiety and depression, symptom distress and oral chemotherapy adherence. The intervention group showed statistically significantly better overall treatment adherence and lower unplanned readmission rate.

CONCLUSION

Nurse-led case management was effective in improving psychosocial outcomes, treatment adherence and unplanned readmission rate of colorectal cancer patients. A case management model is feasible and effective in colorectal cancer patients and in hospital-dominated healthcare systems where primary care is underutilized.

Psychometric properties of the Spanish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)

PURPOSE

The aim of this study was to analyze the internal structure of the EORTC QLQ-C30, to examine the validity and normative data for cancer patients.

METHOD

Exploratory and Confirmatory factor analyses were conducted to explore the scale's dimensionality and test for strong measurement invariance across sex and tumor site. All the analyses were based on a multicenter cohort of 931 patients who completed the Brief Symptom Inventory (BSI-18) and the EORTC QLQ-C30.

RESULTS

Our findings indicate that the EORTC QLQ-C30 has acceptable psychometric properties and an internal structure that is well accounted for a bifactor model: a general factor that evaluates quality of life and a group factor that would analyze physical health that would be defined by physical function, role function, and fatigue. The result of the multi-group CFA revealed a strong invariance according to sex, tumor, and over time. Reliability of the EORTC exceeding 0.86 and the simple sum of the items of the scale was a good indicator of oncology patients' quality of life. Both factors correlate closely with depression, anxiety, and psychological distress and are sensitive to change, especially the quality of life, with a significant decrease in the post-test.

CONCLUSION

The Spanish version of the EORTC QLQ-C30 proved to be a valid, reliable instrument to appraise quality of life in cancer patients. The normative data collected from this study may be useful for the early detection of initial symptoms of deterioration of quality of life in oncology patients.

Health-related quality of life for early-stage cervical cancer survivors after primary radical surgery followed by radiotherapy versus radical surgery alone

This study compared the quality of life (QoL) of 265 stage IA2-IIA cervical cancer patients treated with radical surgery alone (group 1: 137 patients) versus those who underwent primary radical surgery followed by radiotherapy (group 2: 128 patients) and identified clinical characteristics that predict the poor quality of life. All participants completed quality of life questionnaires: EORTC QLQ-C30 and CMU cervical cancer QoL. For the EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL scale and summary scores. Group 1 participants had better scores on the physical functioning domain and some symptom scales/items. For the CMU Cervical Cancer QoL, group 1 participants had better scores on gastrointestinal, lymphatic, and sexual/hormonal domains. In multivariable analysis, adjuvant radiation was consistently associated with poor quality of life in most domains. In general, early-stage cervical cancer survivors had a satisfactory quality of life. The clinical significance of the quality of life score differences between the study groups remains debateable.Impact statementWhat is already known on this subject? For women with early cervical cancer, surgery is the main treatment providing not only a good chance for a cure by total removal of the cancer but also an opportunity to preserve the hormone-producing function of the ovary as well as the flexibility of the vagina. However, radiation treatment may be indicated after surgery in some patients depending on the findings from surgery. Because of the concern about increased complications and decreased long-term quality of life following the combined treatments, some may elect to avoid surgery and receive radiation alone in the first place. In this study, we compared the quality of life of women who had surgery alone to those who had surgery followed by radiation. This information is currently lacking in the medical literature.What do the results of this study add? We found that, in general, women with early cervical cancer had a satisfactory quality of life. For a patient who is surgically fit and chooses to receive primary surgery, if radiation is subsequently required, she could still expect the acceptable long-term quality of life-although slightly less satisfactory than receiving surgery alone but not inferior to those who receive primary radiation treatment.What are the implications of these findings for clinical practice and/or further research? These findings will be useful for pre-treatment counselling and posttreatment supportive care. The information regarding disease-related and treatment-induced morbidity should be thoroughly discussed with the patients before and after treatment. Also, the use of questionnaires examining general well-being together with a cancer-specific quality of life is recommended for the systematic evaluation of cancer survivors.

The prevalence of depressive disorder and its association in Thai cervical cancer patients

PURPOSE

The purpose of this study is to examine the prevalence, associated factors and quality of life associated with depressive disorder in cervical cancer patients.

PATIENTS AND METHODS

This cross-sectional study was carried out in a gynecologic oncology clinic of a university hospital in Northern Thailand from October 2018 to August 2019. Two-hundred cervical cancer patients were screened for depressive disorder using the nine-item Patient Health Questionnaire (PHQ-9), and psychiatrists interviewed eligible patients to confirm diagnoses. We measured the quality of life using questionnaires from the European Organisation for the Research and Treatment of Cancer: Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Cervical Cancer Module 24 (EORTC QLQ-Cx24). Associated factors, including comorbidity, fatigue, and pain, were collected using the Charlson Comorbidity Index (CCI), the eleven-item Chalder Fatigue Scale (CFQ 11), and the visual analog scale (VAS) for pain, respectively.

RESULTS

Twenty-seven (13.5%) cervical cancer patients were diagnosed with depressive disorder by psychiatrists according to the DSM-5. Depressive disorder was related to a worse quality of life in these patients. A binary logistic regression analysis revealed that depressive disorder among these patients was linked with these factors: high fatigue score (aOR: 1.35; CI: 1.18-1.53), high pain score (aOR: 1.25; CI: 1.02-1.54), no perception of social support, (aOR: 3.12; CI: 1.11-8.81), and no previous surgical treatment for cervical cancer (aOR: 2.99; CI: 1.08-8.29).

CONCLUSION

The depressive disorder prevalence was 13.5% in Northern Thai cervical cancer patients. In this demographic, cervical cancer patients-who reported high fatigue or pain scores, did not perceive social support, or had no previous cervical cancer surgery- were more likely to have depressive disorder.

Effect of cancer stage on health-related quality of life of patients with epithelial ovarian cancer

We compared the quality of life (QoL) of women with early versus advanced epithelial ovarian cancer and examined predicting factors for the poor QoL. We classified 157 participants into 108 with early disease (stage I-II) and 49 with advanced disease (stage III-IV). They completed two questionnaires: EORTC QLQ-C30 and Chiang Mai University (CMU) ovarian cancer QoL. For EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL, functional scales, and summary scores. The advanced group had worse scores on symptom scales specifically appetite loss and constipation. For CMU Ovarian Cancer QoL, the advanced group had worse scores only in the gastrointestinal domain but not in urinary, lymphatic, and sexual/hormonal domains. These findings remained mostly unchanged after excluding those with recurrence. In multivariable analysis, currently receiving treatment was consistently associated with worse QoL scores. The advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy.IMPACT STATEMENTWhat is already known on this subject? Survival outcome for women with epithelial ovarian cancer varies depending mainly on stage. Those who survive advanced stage disease could expect long-term disease and treatment-related morbidities that significantly affected QoL. However, there has been very limited information regarding QoL of women who have the early disease in comparison to those with more advanced disease especially in the context of Asian culture.What do the results of this study add? Apart from the higher prevalence of gastrointestinal symptoms reported by the patients with advanced disease, the general well-being and other symptom-specific domains of QoL were comparable between women with early and advanced diseases. Receiving treatment is a consistent predictor for poor QoL.What are the implications of these findings for clinical practice and/or further research? In comparison to early-stage epithelial ovarian cancer, the advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy. This information will be useful for patient counselling. Future research should examine the underlying causes of this finding.

Temporal stability of quality of life assessments in cancer patients

Quality of life (QoL) is an important outcome criterion in cancer research and practice. Multiple studies have been performed to test the short-term temporal stability (1 day–2 weeks) of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, but its stability over longer periods of time is largely unknown. The EORTC QLQ-C30 was administered at two time points between 3 and 12 months apart in six samples of cancer patients with varying characteristics (N between 298 and 923). Averaged across the six samples, the coefficients of temporal stability (intra-class correlation coefficients ICC) were between 0.31 and 0.59 for the single scales. The 2-item global health/QoL scale showed a mean coefficient of 0.44. When the stability coefficients were calculated separately for males and females and for younger vs. older patients, no systematic gender or age differences were found in the temporal stability of the QoL scales, though the stability was slightly higher in males (vs. females) and in older subgroups (vs. younger subgroups). It is nearly impossible to predict the course a cancer patients’ QoL will take over a several month period. Repeated measurements are necessary to track QoL developments.

Assessing the acceptability, reliability, and validity of the EORTC Quality of Life Questionnaire (QLQ-C30) in Kenyan cancer patients: a cross-sectional study

BACKGROUND

In oncology practice, eliciting the patient's perspective on their quality of life (QOL) adds important information and value to their treatment and care. The European Organization for Research and Treatment of Cancer QOL questionnaire (EORTC QLQ-C30) is the most commonly used tool for this purpose but has not been validated in Kenya. The present study aimed to conduct a preliminary assessment of the QOL among Kenyan cancer patients and examine the psychometric properties of the tool in this population. One hundred patients with heterogeneous types of cancer were enrolled in this cross-sectional study between July and August 2019. The EORTC QLQ-C30 questionnaire was administered to patients using either the English or Kiswahili official version. Descriptive statistics were used to assess patient demographics and clinical characteristics. The psychometric properties of the EORTC QLQ-C30 were evaluated in terms of acceptability, internal consistency, and construct validity using statistical software packages, STATA and SPSS.

RESULTS

The EORTC QLQ-C30 was found to be acceptable for use in our patient population as indicated by high compliance and low missing responses. Of the 100 patients, 66 were able to self-administer the questionnaire. The average time for completion was 13 min. Preliminary QOL assessment indicated an average QOL in Kenyan cancer patients (53 ± 27). Among the function scales, participants scored the lowest on the social function scale (51 ± 36) whereas among the symptom scales, participants scored the highest on the financial difficulties scale (79 ± 31). Cronbach's alpha coefficient values ranged from 0.72-0.95, illustrating the reliability of the scales measured. Interscale correlations were statistically significant (p < 0.05), indicating clinical validity of the data collected. The magnitudes of the correlations between the physical functioning scale and the role functioning, pain, and fatigue scales were consistent with the values published in other studies across different geographical populations, further cross-validating the results from our study.

CONCLUSION

The results from this study provide important first insights into using EORTC QLQ-C30 in the Kenyan population. We conclude that the questionnaire is an acceptable, reliable, and valid instrument for measuring the QOL in cancer patients in Kenya and recommend its use in clinical practice.

Reliability and validity of Amharic version of EORTC QLQ-C30 and QLQ-BR23 modules for assessing health-related quality of life among breast cancer patients in Ethiopia

BACKGROUND

Breast cancer is the most common cancer among women and it affects quality of life of those women. So far, the two most frequently used tools for assessing health related quality of life in breast cancer patients, EORTC QLQ-C30 and EORTC QLQ-BR23 modules, were not validated in Ethiopia. Hence, the present study aimed to assess the psychometric properties of the tools among Ethiopian breast cancer patients.

METHODS

Institutional based longitudinal study was conducted from January 1 to May 1, 2017 GC at only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. A total of 146 patients who visited the facility during that period, with no missing quality of life data, were selected for analysis. The psychometric properties of the EORTC QLQ-C30 and EORTC QLQ-BR23 were evaluated in terms of reliability, convergent, divergent, construct and clinical validity using SPSS version 22.

RESULTS

Satisfactory internal consistency reliability (Cronbach's α coefficients > 0.7) was confirmed, except for cognitive function (α = 0.516) of EORTC QLQ-C30 and body image (α = 0.510) of EORTC QLQ-BR23. Multiple-trait scaling analysis demonstrated a good convergent and divergent validity. No scaling errors were observed. Most items in EORTC QLQ-BR23 possessed a weak or no correlation with its own dimension in EORTC QLQ-C30 (r < 0.4) except with some of symptom scales. A statistically significant chemotherapy induced quality of life scores changes (P ≤ 0.05) were observed in all dimensions of both instruments between baseline and the end of first cycle chemotherapy, except for body image (P = 0.985) and sexual enjoyment (P = 0.817) of EORTC QLQ-BR23, indicating clinical validity.

CONCLUSION

Amharic version of the EORTC QLQ-C30 and EORTC QLQ-BR23 modules are valid and adequately reliable tool and can be used for clinical and epidemiological cancer researches to study the health related quality of life (HRQoL) of women with breast cancer in Ethiopia.

Function and quality of life among primary osteosarcoma survivors in Iran: amputation versus limb salvage

PURPOSE

This study aimed to evaluate the psychometric properties of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) in Iranian osteosarcoma patients and apply this to compare the functional level, quality of life, symptoms and financial burden of the patients who underwent amputation and limb-salvage operations.

METHODS

This study was conducted at the main referral orthopedic centers in the southwest of Iran from 2006 to 2016. After complete review of medical records, 48 patients were invited to attend the outpatient clinic and participate in the study via initial telephone interview. All data were entered in the Statistical Package for the Social Sciences version 15.0, and p values <0.05 were considered statistically significant.

RESULTS

In total, 48 patients with extremities osteosarcoma completed the study. Of these, 31 had been treated with limb-salvage operation and 17 had undergone amputation. In functioning subscale, all the mean score of items, except social function, were higher in the limb salvage group than the amputee group. The mean scores (SD) of global health and quality of life were 64.5(13.2) and 61.2± 12.4 in the limb salvage and amputee groups, respectively. In the financial impact subscale, the mean score (SD) in the limb salvage group was 68.8± (29.7) compared to 74.5(25.0) in the amputee group.

CONCLUSION

Results support the responsiveness of the EORTC QLQ-C30 for Iranian osteosarcoma patients. Applying this questionnaire revealed similar functional outcome, quality of life, symptoms and financial burden between amputation and limb-salvage groups.

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: factorial models to Brazilian cancer patients

Objective

To evaluate the psychometric properties of the seven theoretical models proposed in the literature for European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), when applied to a sample of Brazilian cancer patients.

Methods

Content and construct validity (factorial, convergent, discriminant) were estimated. Confirmatory factor analysis was performed. Convergent validity was analyzed using the average variance extracted. Discriminant validity was analyzed using correlational analysis. Internal consistency and composite reliability were used to assess the reliability of instrument.

Results

A total of 1,020 cancer patients participated. The mean age was 53.3±13.0 years, and 62% were female. All models showed adequate factorial validity for the study sample. Convergent and discriminant validities and the reliability were compromised in all of the models for all of the single items referring to symptoms, as well as for the “physical function” and “cognitive function” factors.

Conclusion

All theoretical models assessed in this study presented adequate factorial validity when applied to Brazilian cancer patients. The choice of the best model for use in research and/or clinical protocols should be centered on the purpose and underlying theory of each model.

Whey Protein Supplementation Improves Nutritional Status, Glutathione Levels, and Immune Function in Cancer Patients: A Randomized, Double-Blind Controlled Trial

Clinical side effects from medical therapy play an important role in causing malnutrition among cancer patients. Whey protein isolates (WPIs) have the potential to improve the nutritional status of cancer patients. The present study determined the effects of whey protein supplementation on nutritional status, glutathione (GSH) levels, immunity, and inflammatory markers in cancer patients in Thailand. A total of 42 cancer patients (41-63 years old) who received intravenous chemotherapy were randomized in a double-blind controlled trial at the National Cancer Institute in Thailand. Patients received 40 g of WPI plus zinc and selenium (intervention group, n = 23) or a maltodextrin oral snack (control group, n = 19) every day during the daytime for 12 weeks. Nutritional status, GSH levels, immunity, and inflammatory markers were assessed at baseline, 6, and 12 weeks. Whey protein supplementation significantly increased albumin (2.9%) and immunoglobulin G (4.8%) levels compared to the control group at week 12. Controls showed a significantly lower percent change in GSH levels (6.0%), whereas there was a significant time-dependent increase in the intervention group (11.7%). Whey protein supplementation improved nutrition status scores in the intervention group compared to the control. These data indicate that whey protein supplementation can increase GSH levels and improve nutritional status and immunity in cancer patients undergoing chemotherapy. These results will facilitate implementation of malnutrition risk prevention strategies and improve protein status, including immune function, during chemotherapy.

Health related quality of life of gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia

BACKGROUND

Being diagnosed with gynaecologic malignancy certainly will have different sequelae which can hamper quality of life (QOL).This study aimed to assess health related quality of life (HRQOL) among gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia.

METHODS

This study employed facility-based cross-sectional study design on 153 gynaecological cancer patients attending TASH using the Amharic version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). We used descriptive statistics, independent t test and one way analysis of variance (ANOVA) in statistical analysis.

RESULTS

The mean Global Health Status (GHS) was 40.95(SD ± 24.35) and of the functional scores, social function was most affected (42.26, SD ± 32.08), whereas cognitive function is the least affected domain (mean = 88.21, SD ± 18.49). The highest score on the symptom scores was found to be financial difficulties (mean = 64.76, SD ± 32.43) followed by pain (mean = 55.12, SD ± 29.64) and fatigue (mean = 53.97, SD ± 28.54); the lowest score on the contrary was scored for diarrhea (mean = 1.19, SD ± 7.38). As stage increases there was a statistically significant reduction in GHS (p = 0.005) and in all functional score domains except the physical and emotional function. Advancement in stage of the disease has also affected significantly the symptom score domains except financial difficulties, nausea /vomiting and diarrhea. Patients who never went to school have scored a statistically significant lower score in GHS, physical function, role function and social function (p < 0.05).

CONCLUSION

GHS, social function, financial difficulties, pain and fatigue were the most affected domains; however, cognitive function and diarrhea were less affected components of HRQOL of gynaecologic cancer patients. Place of residence, educational status, marital status, payment type, cancer type and stage of the disease were associated with different quality of life scores.

Validity and Reliability of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 - Tagalog among Adult Filipinos with Differentiated Thyroid Cancer

Objective

This study aims to determine the convergent and discriminant validity and internal consistent reliability of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Tagalog among adult Filipinos with differentiated thyroid cancer (DTC).

Methodology

104 adult Filipinos with DTC at various disease stages self-administered the EORTC QLQ-C30 version 3 Tagalog and Short Form-36 (SF-36) version 2 Tagalog. Concurrent validity between conceptually-related scales from both tools was determined. Convergent and discriminant validity of multi-item scales of the EORTC QLQ-C30 Tagalog were assessed by Spearman’s correlation. Cronbach's α was computed.

Results

The EORTC QLQ-C30 Tagalog showed moderate correlation with similar scales in the SF-36 Tagalog particulary for physical, role and social functioning, pain, and global health (r=0.42-0.48, p<0.001). It showed satisfactory item-domain convergent and discriminant validity for all scales except pain, fatigue, physical and cognitive functioning. Internal consistent reliability was good with cronbachs α ranging from 0.77 to 0.88 for global health, emotional and role functioning and symptom scale of nausea/vomiting.

Conclusion

The EORTC QLQ-C30 Tagalog had acceptable convergent and discriminant validity and internal consistent reliability for the scales of global health, role, social and emotional functioning and nausea/vomiting when applied among adult Filipinos with DTC.

Using Quality of Life Scales with Nutritional Relevance after Gastrectomy: a Challenge for Providing Personalized Treatment

Purpose

This study evaluated the changes in nutritional status based on quality of life (QoL) item-level analysis to determine whether individual QoL responses might facilitate personal clinical impact.

Materials and Methods

This study retrospectively evaluated QoL data obtained by the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Stomach (QLQ-STO22) as well as metabolic-nutritional data obtained by bioelectrical impedance analysis and blood tests. Patients were assessed preoperatively and at the 5-year follow-up. QoL was analyzed at the level of the constituent items. The patients were categorized into vulnerable and non-vulnerable QoL groups for each scale based on their responses to the QoL items and changes in the metabolic-nutritional indices were compared.

Results

Multiple shortcomings in the metabolic-nutritional indices were observed in the vulnerable groups for nausea/vomiting (waist-hip ratio, degree of obesity), dyspnea (hemoglobin, iron), constipation (body fat mass, percent body fat), dysphagia (body fat mass, percent body fat), reflux (body weight, hemoglobin), dry mouth (percent body fat, waist-hip ratio), and taste (body weight, total body water, soft lean mass, body fat mass). The shortcomings in a single index were observed in the vulnerable groups for emotional functioning and pain (EORTC QLQ-C30) and for eating restrictions (EORTC QLQ-STO22).

Conclusions

Long-term postoperative QoL deterioration in emotional functioning, nausea/vomiting, pain, dyspnea, constipation, dysphagia, reflux, eating restrictions, dry mouth, and taste were associated with nutritional shortcomings. QoL item-level analysis, instead of scale-level analysis, may help to facilitate personalized treatment for individual QoL respondents.

Long-term Quality of Life After Distal Subtotal and Total Gastrectomy: Symptom- and Behavior-oriented Consequences

OBJECTIVE

This study assessed long-term quality of life (QoL) after subtotal gastrectomy (STG) and total gastrectomy (TG) by comparing groups matched by a set of patient factors at and beyond postoperative 5 years. The cause of QoL gaps based on symptomatic and behavioral consequences of surgery were investigated.

BACKGROUND

Survivors after STG and TG were matched by a set of patient factors (age, sex, stage, chemotherapy, and postoperative period). QoL data were obtained from 53 and 36 pairs of survivors at and beyond postoperative 5 years, respectively.

METHODS

The European Organization for Research and Treatment of Cancer QoL Questionnaire (QLQ)-C30 and QLQ-STO22 were used to assess QoL. QoL comparisons between STG and TG groups were made for 5-year survivors and long-term survivors.

RESULTS

Five-year survivors after TG showed significantly worse QoL in social functioning, nausea and vomiting, eating restrictions, and taste. For long-term survivors, QoL inferiority of the TG group was observed only in eating restrictions. Among 4 items constituting eating restrictions, the TG group tended to exhibit worse QoL in 2 items (enjoyable meals and social meals).

CONCLUSIONS

Although 5-year survivors after TG still suffer from QoL inferiority from symptomatic and behavioral consequences of surgery, inferiority from behavioral consequences will persist even after symptomatic inferiority to STG survivors is no longer valid. Efforts to ameliorate persistent QoL inferiority in TG survivors should be directed toward restoring dietary behaviors, where TG survivors are prevented from enjoyable meals and social meals.

Reliability and Validity of Amharic Version of EORTC QLQ-C 30 Questionnaire among Gynecological Cancer Patients in Ethiopia

BACKGROUND

Cancer is a growing public health problem worldwide. The focus of cancer treatment, in addition to curation, is improving the quality of life (QOL). This study aimed to assess the reliability and validity of Amharic version of European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) among gynecological cancer patients in Ethiopia.

METHODS

A facility-based cross-sectional study was conducted using the Amharic version of EORTC QLQ-C30 on 153 gynecological cancer patients in Tikur Anbassa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Descriptive statistics, correlation analysis and multivariable linear regression were employed in statistical analysis.

RESULTS

The Amharic version of EORTC QLQ-C30 had a Cronbach's α value of 0.81. The internal consistency for each domain of EORTC QLQ-C30 was also acceptable (Cronbach's α >0.7) except for cognitive function domain (Cronbach's α = 0.29). Stepwise multivariable linear regression analysis showed that emotional functioning (p<0.001), fatigue (p<0.001) and social functioning (p = 0.004) were the determinative scales of EORTC QLQ-C30 on global health status (GHS). The clinical validity test (Known group validity) showed that there were significant differences in score for twelve out of 15 domains, between surgery and radiation scheduled patients. All items of emotional function, role function, fatigue, and GHS meet the discriminate validity criterion.

CONCLUSION

The Amharic version of EORTC QLQ-C30 found to be reliable and had an acceptable validity to assess the QOL for gynecological cancer patients. We recommend further work on the validity and responsiveness of the EORTC QLQ-C30 with stronger design.

The need for community pharmacists in oncology outpatient care: a systematic review

Background One-third of all deaths in Europe each year are attributable to cancer. Issues relating to cancer care, therefore, will continue to expand. To manage the increased challenges-including doctor shortages, an ageing population, and rural distribution of supplies-community pharmacists will likely be required to assume responsibility within oncology care. Aim of the review To assess the need for further investigation into quantity and utility of community pharmacists' interventions in assisting oncology outpatients. Methods Initial search terms for identifying relevant literature within the PubMed database were informed by four key questions. Study selection for the systematic review was performed based on inclusion and exclusion criteria, which were defined a priori using the PICO tool. Literature searches identified 2470 papers, for which titles and abstracts were reviewed. Of these, 220 papers were retained for detailed analysis. The full texts of these manuscripts were then screened by applying the inclusion criteria. The remaining 68 papers were included in the systematic review. Results Several models of pharmacists' interventions in inpatient, medium, and outpatient care have proven to be successful, have been consistently efficacious, and have positively influenced patient outcomes. Importantly, the quantity of scientific research, and thus of reported beneficial outcomes, in outpatient care is much lower than that conducted for inpatient and medium care. Conclusion Based on our findings, we suggest that further investigation of community pharmacists' interventions into oncology outpatient assistance is necessary, and that further research should be conducted to address this need.

Therapeutic effect of Jinlongshe Granule () on quality of life of stage IV gastric cancer patients using EORTC QLQ-C30: A double-blind placebo-controlled clinical trial

OBJECTIVE

To evaluate the impact of Jinlongshe Granule (, JLSG) on quality of life (QOL) of stage IV gastric cancer patients.

METHODS

This randomized, double-blind and placebo-controlled clinical trial included 50 patients with advanced gastric cancer. They were equally randomized into a JLSG group and a placebo group. Patients in both groups received routine Chinese herbal decoctions according to Chinese medicine (CM) treatment based on syndrome differentiation. Patients in JLSG group received additional JLSG, and those in the placebo group received an additional placebo. In the JLSG group, 19 patients who completed the study were used for analysis. In the placebo group, finally the data of 20 patients who completed the study were used for analysis. The treatment course was at least 3 months, and the follow-up duration was at least 6 months in 5 interviews. Repeated measurements of the subscale items and individual items in European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30) obtained at the 5 interviews were compared using different patient groups, changes over time and changes within one group over time independently to observe the tendency of changes in the scores.

RESULTS

Using time as the variant, there was signifificant difference in 4 functional scales (physical, role, emotional and social, P<0.05), 3 symptom scales (fatigue, nausea and vomiting and pain,P<0.05) and a global health status/QOL scale (P<0.05) and 6 single symptoms dyspnoea (P>0.05), insomnia (P<0.05), appetite loss (P<0.05), constipation (P<0.05), diarrhea (P>0.05) and financial difficulties (P<0.05). There was also signifificant difference in these items between the two groups when the placebo group and group over time were used as variants (P<0.05 or P<0.01).

CONCLUSION

Additional use of JLSG on the basis of routine CM treatment could improve the somatic function, role function, emotional function, social function, cognitive function and general QOL of patients with advanced gastric cancer, and relieve the symptoms of fatigue, nausea and vomiting, pain, loss of appetite and constipation.

Conceptual structure of the Taiwan Chinese version of the EORTC QLQ-C30

OBJECTIVE

This study aimed to evaluate the conceptual structure of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) by analyzing data collected from patients with major cancers in Taiwan. The conceptual structure underlying QLQ-C30, including higher-order factors, was explored by structural equation modeling (SEM).

METHODS

The Taiwan Chinese version of the EORTC QLQ-C30 was used as the measuring instrument. Higher-order models, including mental health/physical health, mental function/physical burden, symptom burden/function, single latent health-related quality of life, formative symptom burden/function, and formative health-related quality of life, were tested.

RESULTS

Study subjects included 283 patients with breast, lung, and nasopharyngeal cancers. The original QLQ-C30 multi-factorial structure demonstrated poor composite reliability of the cognitive function subscale. The formative symptom/burden model was favored by model fit indices, further supporting causal-indicator duality, but was compromised by unexpected associations between symptomatic subscales and latent factors. The formative health-related quality of life was proposed with a single second-order latent factor where symptomatic subscales remained formative. Two additional symptom measures from the formal cognitive function subscale with the formative health-related quality-of-life model were proposed as the alterative conceptual structure for the Taiwan Chinese QLQ-C30.

CONCLUSIONS

Results of the current study represent the complete SEM approach for the EORTC QLQ-C30. The formative health-related quality-of-life model with elimination of cognitive function enhances the conceptual structure of the Taiwan Chinese version with parsimonious fit and interpretability.

Evaluation of reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, Albanian version) among breast cancer patients from Kosovo

PATIENTS AND METHODS

A sample of breast cancer patients (n=62 women) were interviewed for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) in Albanian. Reliability of the questionnaire was considered acceptable if Cronbach's alpha was ≥0.70. Item convergent-discriminant validity was tested through multitrait scaling analysis. Construct validity was tested under the hypotheses that QLQ-C30 interscale correlations would have an acceptable value of ≥0.40 and as well as by known group comparisons assessing differences of patient subgroups with reference to disease stage and education level.

RESULTS

The mean age of the patients was 50 years (standard deviation: 10.9 years). Cronbach's alpha ranged from 0.54 for the cognitive functioning scale to 0.96 for the global health quality of life (GH/QoL) scale. In multitrait scaling analysis, the strength of Spearman's correlations between an item and its own subscale was ≥0.40, with the exception of item 5 (ρ=0.22); results for item discriminant validity were satisfactory, with the exception of item 5, which showed higher correlation with other subscales than with its own physical functioning. The Spearman's interscale coefficients generally were correlated with each other. Results of known group comparisons did not show significant differences in terms of disease stage. Regarding education level, patients with high school/university education had better functional scales scores only in certain subscales compared to other subgroups; furthermore, patients with secondary school education had better GH/QoL compared to other subgroups of patients.

CONCLUSION

The EORTC QLQ-C30 (v3.0) in Albanian was found to be valid and reliable for women with breast cancer and could be considered as a starting point for further evaluation study.

Validity, reliability and understanding of the EORTC-C30 and EORTC-BR23, quality of life questionnaires specific for breast cancer

OBJECTIVE

To validate and assess reliability and understanding of the EORTC-C30 quality of life questionnaire and its breast cancer specific module, the EORTC-BR23.

METHODS

This study was conducted at the AC Camargo Cancer Hospital, São Paulo, Brazil. A total of 100 women diagnosed with breast cancer were interviewed. Internal consistency, confirmatory factorial analysis, convergent validity, construct validity and degree of understanding were examined. Reliability was assessed by comparison of means at times 1 and 2, inter-class coefficient and Bland-Altman graphics.

RESULTS

Cronbach's alpha ranged from 0.72 to 0.86 for the EORTC-C30 and from 0.78 to 0.83 for the EORTC-BR23 questionnaire. Most questions were confirmed in the confirmatory factorial analysis. In the construct validity analysis, the questionnaires were capable of differentiating patients with or without lymphedema, apart from the symptom scales of both questionnaires. Both questionnaires presented a significant correlation in most domains of the SF-36, in the convergent validity analysis. Only a few criticisms were reported concerning questions, and the mean grade of understanding was high (C30 = 4.91 and BR23 = 4.89). The questionnaires presented good rates of reliability, with the exception of the functional scale of the C30 and the symptom scale of the BR23.

CONCLUSIONS

The EORTC-C30 and EORTC-BR23 quality of life questionnaires were validated, presented good rates of reliability and are easily understood, allowing them to be used in Brazil to assess quality of life among women with breast cancer.

Further evaluation of the EORTC QLQ-C30 psychometric properties in a large Brazilian cancer patient cohort as a function of their educational status

PURPOSE

The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) is considered a valid instrument for use in Brazil. However, the previous Brazilian validation study included only 30 lung cancer patients and only measured test-retest reliability. The aim of this study was to evaluate the psychometric properties of the EORTC QLQ-C30 in a sample of cancer patients at different educational levels who completed the instrument administered by an interviewer.

METHODS

Data from six prospective studies conducted by the same group of researchers were combined in this study (N = 986).

RESULTS

Reliability was assessed using Cronbach's alpha coefficient, all values of which were >0.7, with the exception of cognitive functioning, social functioning, and nausea and vomiting (α = 0.57, α = 0.69, and α = 0.68, respectively). In multi-trait scaling analysis, convergent and divergent validity were considered adequate (validity indices were 91.6 and 97.4%). In general, moderate to strong correlations were found between the subscales of the EORTC QLQ-C30 and its respective dimensions from the WHOQOL-bref, the hospital anxiety and depression scale, and the Edmonton Symptom Assessment System (ESAS) instruments. In addition, the EORTC QLQ-C30 was able to differentiate groups of patients with distinct performance statuses and types of treatment (known-group validation). Statistical analyses were also performed on educational status, yielding similar results.

CONCLUSIONS

Detailed psychometric property data using the EORTC QLQ-C30 in Brazil are added by this study. In addition, we demonstrated that this instrument is in general reliable and valid regardless of the patient educational level.

Validating and improving the reliability of the EORTC qlq-c30 using a multidimensional Rasch model

OBJECTIVE

The reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) has not been examined while taking into account the correlation between subscales. The reliability of the EORTC QLQ-C30 subscales is modest, thus limiting their utility in both clinical and research settings. The purpose of this study was to validate the factor structure of multiple-item subscales of the EORTC QLQ-C30 and to improve their reliability by means of an item response analysis by using the multidimensional partial credit model.

METHODS

A total of 2295 patients with complete data were used for the analysis. One- and nine-dimensional partial credit models were used to fit the data to validate the construct validity of the multiple-item subscales of the QLQ-C30.

RESULTS

The model comparison showed that the nine-dimensional factor structure of multiple-item subscales was satisfactory. The multidimensional partial credit model fit data of the multiple-item subscales of the QLQ-C30 reasonably well. The estimated test reliabilities of each domain obtained from the multidimensional approach were higher than those obtained from the unidimensional approach.

CONCLUSIONS

The constructs represented by the multiple-item subscales of the QLQ-C30 were validated. The improved reliability of the multiple-item subscales of the QLQ-C30 under the multidimensional approach can facilitate their applications in clinical and research settings.

Validation of the Mexican-Spanish version of the EORTC QLQ-C30 and BR23 questionnaires to assess health-related quality of life in Mexican women with breast cancer

The aim of this study was to validate the Mexican-Spanish version of The European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23 questionnaire. The translation procedure followed EORTC guidelines. QLQ-C30 and QLQ-BR23 instruments were completed by Mexican women with breast cancer, attending a teaching referral cancer centre from February 2009 to January 2010. Patients were divided in two groups: (1) Patients with early stage of breast cancer; and (2) Patients with locally advanced breast cancer (LABC). Reliability and validity tests were performed, and validity over time (responsiveness) was conducted in a subset of patients. Two hundred and thirty-four women (mean age, 52.3 years) completed both questionnaires. Convergent and divergent validity was adequate. Cronbach's alpha of all multi-item scales showed values ≥0.7 except for Cognitive and Breast symptoms scales (0.52 and 0.65 respectively). Patients with early stages (n= 77) showed better functional scores and lower symptoms scores than patients with LABC (n= 157). Score means variation after responsiveness analysis demonstrated high sensitivity to change after breast cancer surgery. The Mexican-Spanish version of the EORTC QLQ-BR23 questionnaire is a valid and suitable instrument to estimate HRQL in patients with breast cancer.

Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations

BACKGROUND

This review aims to assist cancer clinical researchers in choosing between the two most widely used measures of cancer-specific health-related quality of life: the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Functional Assessment of Cancer Therapy-General (FACT-G).

MATERIALS AND METHODS

Information on QLQ-C30 and FACT-G content, scale structure, accessibility and availability was collated from websites and manuals. A systematic review was undertaken to identify all articles reporting on psychometric properties and information to assist interpretability. Evidence for reliability, validity and responsiveness was rated using a standardised checklist. Instrument properties were compared and contrasted to inform recommendations.

RESULTS

Psychometric evidence does not recommend one questionnaire over the other in general. However, there are important differences between the scale structure, social domains and tone that inform choice for any particular study.

CONCLUSIONS

Where research objectives are concerned with the impact of a specific tumour type, treatment or symptom, choice should be guided by the availability, content, scale structure and psychometric properties of relevant European Organisation for the Research and Treatment of Cancer versus Functional Assessment of Chronic Illness Therapy modules. Because the FACT-G combines symptoms and concerns within each scale, individual items should always be reviewed within the context of specific research objectives. Where these issues are indecisive, researchers are encouraged to use an algorithm at the end of the current article.

Validation of the simplified Chinese version of EORTC QLQ-C30 from the measurements of five types of inpatients with cancer

BACKGROUND

European Organization for Research and Treatment quality of life (QOL) questionnaire (QLQ-C30) has been used frequently and many language versions have been developed, including the simplified Chinese version. It is important to study psychometric properties of the simplified Chinese version from the clinical standpoint.

PATIENTS AND METHODS

The simplified Chinese version of the QLQ-C30 was used in a longitudinal study of 600 patients with five types of cancer: lung, breast, head and neck, colorectal, and stomach. The psychometric properties of the scale were evaluated by indicators of validity and reliability coefficients such as Cronbach's alpha and Pearson's correlation coefficient r, standardized response mean (SRM), correlational analysis, t-tests, and structural equation models.

RESULTS

Correlation and structural equation model analyses confirmed good construct validity with root mean square error of approximation 0.054, standardized root mean square residual 0.037, non-normed fit index 0.972, and comparative fit index 0.980. The alpha coefficients for all domains are >0.7 except for cognitive functioning (0.49). The test-retest reliability coefficients for most domains are >0.80 except for appetite loss (0.77) and diarrhea (0.75). The QOL score changes after treatments were of statistical significance with higher or moderate SRM in most domains.

CONCLUSION

The simplified Chinese version of QLQ-C30 has good validity, reliability, and responsiveness and can be used to measure QOL for Chinese cancer patients.

Validation of the Mexican Spanish version of the EORTC C30 and STO22 questionnaires for the evaluation of health-related quality of life in patients with gastric cancer

Health-related quality of life (HRQL) is a fundamental outcome in surgical oncology and culturally valid tools are essential for this purpose. Our aim was to validate the Mexican-Spanish versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire QLQ-C30 and the QLQ-STO22 disease-specific questionnaire module in Mexican patients with gastric cancer (GC). The translation procedure followed EORTC guidelines. Both instruments were completed by patients with GC and analyses were performed within three clinically distinct groups: (1) patients undergoing palliative treatment, (2) patients undergoing treatment with curative intent, and (3) GC survivors. Tests for reliability and validity were performed. One hundred and fifty patients (mean age 54.2 years) completed both questionnaires. Sixty-seven, 55, and 28 patients were allocated to groups 1, 2, and 3, respectively. Compliance rates were high, and questionnaires were well-accepted. Survivors of treatment for GC reported better functional HRQL scores and lower symptom scores than patients in group 2 who were currently undergoing treatment. Patients selected for potentially curative treatment had better HRQL than group 1 (palliative treatments). Scales in the QLQ-C30 and QLQ-STO22 distinguished between other clinically distinct groups of patients. Cronbach's alpha coefficients of 14 scales of both questionnaires were >0.7. Multitrait scaling analysis demonstrated good convergent and discriminant validity. Test-retest scores were consistent. We conclude that the Mexican-Spanish versions of EORTC QLQ-C30 and QLQ-C22 questionnaires are reliable and valid for HRQL measurement in patients with GC and are therefore recommended for use in clinical trials of Mexican community.

Understanding the reliability and validity of the EORTC QLQ-C30 in Turkish cancer patients

Quality of life (QOL) has become an important area to address. The most commonly used QOL tool in oncology is the European Organization for Research and Treatment of Cancer QOL measure (EORTC QLQ-C30). The aim of this study is to examine the reliability and validity of this widely used questionnaire in Turkish language. A total of 114 cancer patients were recruited in this study. The internal consistency of the subscales, concurrent validity between EORTC QLQ-C30 version 3.0 and Short Form-36 (SF-36), the correlations between the subscales of EORTC QLQ-C30 and Hospital Anxiety and Depression scale-Anxiety (HADS-A), and Hospital Anxiety and Depression scale-Depression (HADS-D) were also evaluated. Cronbach's alpha-coefficient for multi-item scales ranged from 0.56 to 0.85, with emotional functioning having the highest Cronbach's alpha-coefficient. General health/QOL subscale was correlated significantly with all other subscales. Modest correlations were found between relevant subscales of SF-36 and EORTC QLQ-C30 scales indicating good convergent validity. Although score of emotional functioning subscale was significantly correlated with HADS-A, no correlation was found with HADS-D. The correlations between general health/QOL and HADS-A and HADS-D were significant though Pearson's coefficients were below 0.4. The EORTC QLQ-C30 version 3.0 is a reliable and valid instrument and suitable for measuring the QOL in cancer patients in Turkey.