Phase III study of the European Organisation for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire

Validation and pilot feasibility study of a novel screener to assess diet, lifestyle and mental health in people living with and beyond cancer: Study protocols

BACKGROUND AND AIM

Current clinical care may not address behavioural and psychosocial elements which can influence quality of life (QoL) and recurrence risk of people living with and beyond cancer (PLWBC). There is a lack of validated tools to assess diet, lifestyle and mental health in PLWBC. We have developed a screener to identify individuals who may need further support beyond cancer recurrence. The aim is two-fold: 1) validate the screener in PLWBC; and 2) carry out a pilot feasibility study (PFS) to explore the impact of a lifestyle complex intervention (diet, physical activity and mental health components) on the QoL of PLWBC.

METHODS

The study will be carried out at the University Hospital Son Espases (Spain) in PLWBC. A face validity study (n = 15) will assess construct interpretation, completion time, and acquiescence of the screener. For construct validity and reproducibility analysis (n = 100), participants will answer the screener together with validated diet, lifestyle, and mental health questionnaires for comparison. Body composition, physical activity, strength and cortisol levels will be assessed using validated instruments. All participants will answer the screener 7-10 days later for reproducibility analysis. Participants will then be randomized (1:1) to the Low Intervention (LI) or the High Intervention (HI) for the PFS study. LI will receive general advice regarding diet, lifestyle and mental health, and HI will receive individual and group sessions with specialised health professionals. Participants will be followed for three months. Primary outcomes include: 1) validity and reproducibility of the screener; and 2) feasibility of a complex intervention to improve QoL of PLWBC. Secondary outcomes include changes in screener answers and body composition.

DISCUSSION

A validated screener which detects PLWBC's needs could be used in follow-up care plans. The PFS will inform on the recruitment of participants and identify potential shortfalls of the design and efficacy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06582498.

Flexibility in patient-reported outcome and health-related quality of life measurement: The EORTC Quality of Life Group measurement strategy

The development of the first European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) health-related quality of life (HRQoL) questionnaires contributed to the systematic uptake of HRQoL as an endpoint in cancer clinical trials, and to the measurement of HRQoL for individual assessment in routine care. Following a modular approach, these patient-reported outcome (PRO) measures (PROMs) ensure that both generic and disease-specific issues are assessed, enabling comparison of PROs across groups and studies. The application of a comprehensive and continually refined methodology for developing and updating these PROMs has been crucial in supporting their psychometric and cross-cultural validity, and their continued implementation in clinical research. However, the advancement of measurement science, the more widespread implementation of PROMs, and the significant evolution of anti-cancer therapies over the last decades have highlighted the need to adopt more flexible approaches to PRO assessment to ensure that PROMs remain relevant and fit-for-purpose. The QLG has responded to this call by implementing more tailored PRO measurement approaches through the development and release of the computerised adaptive test (CAT) version of the EORTC QLQ-C30 (i.e., the EORTC CAT Core) and the EORTC Item Library. The EORTC Item Library is an interactive online platform that allows for the creation of customised questionnaires (item lists) from the pool of available items derived from established EORTC QLG PROMs. The aim of this article is to describe the current EORTC QLG approach to PRO measurement in oncology, covering important historical developments and best practice recommendations.

Long-term health-related quality of life among adolescent and young adult breast cancer survivors

PURPOSE

As the prognosis for adolescents and young adults (AYAs) with breast cancer has improved, long-term health-related quality of life (HRQoL) has become increasingly important. This study aimed to analyze the long-term HRQoL of AYA breast cancer survivors compared to an age-matched normative population and to identify factors associated with HRQoL.

METHODS

Secondary analyses were conducted using data from the SURVAYA study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) was used to assess HRQoL. The Mann-Whitney U test was used to compare HRQoL scores of AYA breast cancer survivors with those of the normative population (n = 409). Linear regression models were constructed to identify patient and treatment characteristics associated with HRQoL.

RESULTS

A total of 944 female AYA breast cancer survivors were included, with a median age of 36.0 years and a median follow-up of 12.2 years. AYA breast cancer survivors scored significantly lower on five functional scales: physical, role, emotional, cognitive, and social, and higher on five symptom scales: fatigue, pain, dyspnea, insomnia, and financial impact compared to the normative population. Being in a relationship, having a positive body image, and adaptive coping were positively associated with HRQoL, while older age, chemotherapy, unemployment, and maladaptive coping were negatively associated.

CONCLUSION

AYA breast cancer survivors experience significantly compromised long-term HRQoL compared to an age-matched normative population. These results highlight the need for tailored follow-up care and long-term support, as well as the importance of shared decision-making about the benefits and risks of treatments before initiation.

Quality of life outcomes in colorectal cancer survivors: insights from an observational study at a tertiary cancer center

PURPOSE

Colorectal cancer (CRC) significantly impacts the quality of life (QoL) of survivors, yet detailed assessments of long-term QoL are sparse. This study evaluates QoL among CRC survivors, examining the influence of different treatments and patient characteristics on outcomes.

METHODS

We conducted a cross-sectional study at a tertiary cancer center in Portugal, enrolling CRC patients who underwent curative surgery from 2013 to 2022. QoL was assessed using the EORTC QLQ-C30 and QLQ-CR29 at 1-, 3-, 5-, and 10-year follow-up intervals. Subgroup analyses were performed based on tumor location, radiotherapy administration, chemotherapy administration, presence of a stoma, and time since treatment, with sociodemographic and clinical factors examined on univariate and multivariate analysis.

RESULTS

Of the 825 eligible patients, 324 were invited and 179 participated (response rate: 55.2%). Overall, patients reported high global QoL and functional scores with low symptom scores, comparable to those of the general population. However, rectal cancer survivors experienced poorer outcomes in role and social functioning, body image, and symptom management. Those receiving radiotherapy or chemotherapy reported more symptoms, with chemotherapy recipients showing lower functional scores. Patients with a stoma had significantly lower QoL across functional and symptom scales. Long-term survivors reported decreased physical functioning. Multivariate analysis identified female gender, open surgery, and chemotherapy as factors associated with reduced QoL.

CONCLUSION

This study highlights significant disparities in QoL outcomes between CRC survivors, with QoL influenced by gender, cancer location, radiotherapy or chemotherapy, stoma presence, and survivorship duration, underscoring the need for personalized support programs and tailored care plans.

SCAPAS-LungCancer-improving supportive care for patients surgically treated for non-small cell lung cancer: protocol for a prospective, longitudinal, observational and exploratory multicentre study

INTRODUCTION AND AIM

Despite global advances in lung cancer treatment, challenges persist in symptom management and supportive care, particularly as the incidence of early-stage diagnoses rises. Patients with non-small cell lung cancer (NSCLC) face symptom burdens compounded by physical, psychological and social factors, alongside the concealment of early-stage symptoms. Research on symptom management in patients with NSCLC remains limited, with a lack of studies exploring patient experiences and clinical management strategies. Moreover, attention to late effects highlights the need for personalised care interventions to address long-term outcomes. The SCAPAS-LungCancer study aims to bridge these gaps by enhancing our understanding of NSCLC symptomatology, late effects and quality of life. The study seeks to identify patients with multiple symptoms and late effects, offering insights for future personalised care interventions to improve patient outcomes and overall well-being.

METHODS AND ANALYSIS

The study employs a multiple-methods approach encompassing qualitative and quantitative investigations to comprehensively explore symptomatology, patient experiences and treatment outcomes in patients with NSCLC undergoing surgical treatment. A prospective, longitudinal, observational and exploratory design is adopted. A longitudinal qualitative study, including individual interviews and ethnographic fieldwork, will be conducted to explore patients' experiences and interactions with clinicians on symptoms and late effects. Additionally, consecutive newly diagnosed patients with NSCLC scheduled for surgery will be recruited in a prospective questionnaire study using patient-reported outcomes. Eligible patients will complete self-reported measures assessing physical and psychosocial symptom burden and late effects, quality of life, social support and unmet needs at baseline and multiple follow-up points post-surgery over a 2-year period. Socio-demographic and medical characteristics are also collected.

ETHICS AND DISSEMINATION

The study is approved by the Danish Data Protection Agency (journal no: 2022-737) and conducted in accordance with Danish Ethics Research Committee guidelines and the Helsinki II Declaration. Participants will provide written informed consent. The results will be reported in peer-reviewed journals.

Employment status among cancer survivors in a Late Effects Clinic in Denmark

PURPOSE

This study aims to investigate changes in employment status among disease-free working-age cancer survivors (CSs) with late effects from diagnosis to their first meeting in the Late Effects Clinic (LEC) and investigate associated patient-reported outcomes of reduced employment status.

METHODS

Retrospective analysis of a cohort of CSs followed in a LEC at a single institution from January, 2022, to March, 2023. Working-age CSs with no current evidence of active cancer were included in this study. CSs completed a baseline questionnaire (EORTC QLQ-SURV100) before their initial consultation. Reduced employment status was defined as transition from being in paid work at diagnosis to working fewer hours or not at all at the first visit. Multivariate linear regression analysis was used.

RESULTS

A total of 119 CSs with diverse cancer types with a mean age of 51 years (range 26 to 70) were included in this study. Eighty percent were female. Of 93 CSs in paid work at diagnosis, 66 (71%) have reduced employment status. Reduced employment status was associated with lower role functioning score (β = -12.3, p = 0.046), higher loss of income score (β = 35.1, p = 0.001), and lower Global health status score (β = - 8.3, p = 0.05).

CONCLUSIONS

This study shows that the majority of CSs seen in the LEC have reduced employment status. This is associated with impaired quality of life.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying and treating late effects early in cancer survivorship are important to secure CSs' labour market attachment and, thus, their financial and social well-being.

Health-related quality of life in 62 patients with diffuse low-grade glioma during a non-therapeutic and progression-free phase: a cross-sectional study

PURPOSE

Few studies have evaluated the health-related quality of life (HRQoL) of patients with diffuse low-grade glioma (LGG) during a clinical and radiological monitoring period. We report a cross sectional cohort study of HRQoL in patients with LGG and compare the results with normative population data. We then explore factors associated with HRQoL.

METHODS

We used the European Organisation for Research and Treatment of Cancer QLQ-C30, BN-20 and the Hospital Anxiety and Depression Scale (HADS) to evaluate HRQoL. Averaged QLQC30 and HADS scores were compared with scores of a normative population. A general linear model multivariate analysis of variance was used to investigate the association between HRQoL and independent factors.

RESULTS

A total of 62 patients with LGG completed HRQoL questionnaires. Compared with a normative population, LGG patients reported statistical and clinically significant lower cognitive, emotional, role and social functioning. Fatigue, anxiety, depression and sleep disturbances were frequently reported. Awake surgery and preserved high Karnofsky Performance Status were found to be independent prognostic factors for better global HRQoL, while radiotherapy was associated with worsened HRQoL.

CONCLUSION

Despite a non-therapeutic and progression free phase, LGG patients report noticeable limitations in several HRQoL subscales. Our study highlights the importance of HRQoL assessment not only at diagnosis or during active therapeutic stage. Further studies are needed to develop better adapted tools of HRQoL assessment.

Health anxiety in cancer patients, assessed with the Whiteley Index

OBJECTIVE

Health anxiety (HA) is frequently observed in patients suffering from a severe disease such as cancer. This study aimed to test the psychometric properties of the Whiteley Index-7 (WI-7) measuring HA and to identify prognostic factors for heightened HA in cancer patients.

METHODS

A sample of 1723 cancer patients, treated in a German rehabilitation clinic, completed the Whiteley Index-7, the Generalized Anxiety Disorder screener GAD-7, the Patient Health Questionnaire PHQ-9, the Fear of Progression questionnaire FoP-Q-12, the Concerns About Cancer Recurrence questionnaire CARQ-4, and two subscales of the EORTC QLQ-SURV100.

RESULTS

The internal consistency of the WI-7 was good (Cronbach's α = 0.85), and the correlations between the WI-7 and other scales were as follows: 0.64 (GAD-7), 0.63 (PHQ-9), 0.75 (FoP-Q-12), 0.71 (CARQ-4), 0.66 (SURV-HD), and 0.75 (SURV-NHO). Women showed markedly higher levels of HA than men (effect size: d = 0.40), and patients aged 60 years and above reported lower levels of HA than younger patients (d = -0.32). Melanoma patients showed the highest HA mean score (M = 10.9), and patients receiving antibody therapy showed heightened levels of HA (M = 10.7). When considering age and sex, the effects of tumor type and treatment become smaller than in the univariate analyses.

CONCLUSION

The WI-7 is a suitable instrument for assessing HA in cancer patients. When evaluating the effects of cancer type or treatment on HA, one has to take into account the age and sex distribution. Younger patients and women deserve special attention regarding HA.

The Pittsburgh Sleep Quality Index (PSQI) Applied to Cancer Patients: Psychometric Properties and Factors Affecting Sleep Quality

OBJECTIVE

Cancer patients frequently report sleep problems. The Pittsburgh Sleep Quality Index (PSQI) is a 19-item instrument for assessing sleep problems. The main objective of this study was to analyze the usefulness of the PSQI in oncological research.

METHODS

A sample of 1,733 cancer patients with mixed diagnoses were included. In addition to the PSQI, the following questionnaires were adopted: the Insomnia Severity Index (ISI), the Jenkins Sleep Scale (JSS) and the sleep scale of the EORTC QLQ-SURV100.

RESULTS

The internal consistency of the PSQI was α = 0.79. Of the PSQI subscales, the subjective sleep quality correlated most strongly with the other sleep instruments (r between 0.68 and 0.77). In total, 69.2% of the sample were poor sleepers; the effect size of the difference between the PSQI total scores of the patients and a general population sample was d = 0.83. Female patients experienced more sleep problems than male patients (d = -0.49), and younger patients (<60 years) reported more sleep problems than older patients (≥60 years) (d = 0.21).

CONCLUSIONS

The PSQI can be recommended for use in clinical practice since its sub-dimensions provide detailed information on the sleep situation of cancer patients.

Spanish Society of Medical Oncology recommendations for comprehensive assessment and care of cancer survivors' needs

This article reviews the contemporary and inclusive definition of cancer survivorship, including patients with and without disease who have completed or continue to undergo treatment. The Spanish Society of Medical Oncology (SEOM) describes in this article the needs of these patients and outlines a care model based on an estimation of cancer incidence and identification of patient needs, to enable the provision of practical actions to achieve effective care. The objectives of this review are to identify the main effects of cancer on survivors and to establish appropriate ways of measuring these effects, as well as discussing the management of physical, psychological and social, occupational, financial, and other health-related needs. We suggest a multidisciplinary care model and training programs for the different professionals involved in care, and highlight challenges and the future role of the SEOM and health-care policy in ensuring optimum care of cancer survivors.

A common metric for questionnaires on health anxiety in cancer patients

After a cancer diagnosis, life is accompanied by worries, concerns and fears that the disease will recur or worsen. These can be normal and useful reactions but may also become so severe that they interfere with everyday functioning. A challenge for patient care is that the theoretical similarity of these reactions, is not consistently conceptualized in practice, hence the empirical comparability of their measures is unclear. Here we intend to show that the theoretical similarity is also empirically justified, and we present a common metric in graphical form that allows direct comparisons between different questionnaires. A total of 1,733 cancer patients completed the Fear of Progression Questionnaire Short Form, Questionnaire on Stress in Cancer Patients-revised version, Concerns About Recurrence Questionnaire, the subscales Health Distress and Negative Health Outlook of the EORTC QLQ-SURV100, and the Whiteley Index. Using a model based on item response theory, we linked the score values of the individual questionnaires. The main outcome of this study is a diagram that can be used to convert the respective values of eight questionnaires on health anxiety to another. All instruments showed a reliability above 0.75 near the mean health anxiety level. The common metric can be used to compare measurements with these questionnaires in terms of the level of health anxiety. Additionally, the reliability of the instruments can be judged at different levels of anxiety. This allows for a better comparability of test results and facilitates communication about the results among experts and with patients.

Actionability of Synthetic Data in a Heterogeneous and Rare Health Care Demographic: Adolescents and Young Adults With Cancer

PURPOSE

Research on rare diseases and atypical health care demographics is often slowed by high interparticipant heterogeneity and overall scarcity of data. Synthetic data (SD) have been proposed as means for data sharing, enlargement, and diversification, by artificially generating real phenomena while obscuring the real patient data. The utility of SD is actively scrutinized in health care research, but the role of sample size for actionability of SD is insufficiently explored. We aim to understand the interplay of actionability and sample size by generating SD sets of varying sizes from gradually diminishing amounts of real individuals' data. We evaluate the actionability of SD in a highly heterogeneous and rare demographic: adolescents and young adults (AYAs) with cancer.

METHODS

A population-based cross-sectional cohort study of 3,735 AYAs was subsampled at random to produce 13 training data sets of varying sample sizes. We studied four distinct generator architectures built on the open-source Synthetic Data Vault library. Each architecture was used to generate SD of varying sizes on the basis of each aforementioned training subsets. SD actionability was assessed by comparing the resulting SD with their respective real data against three metrics-veracity, utility, and privacy concealment.

RESULTS

All examined generator architectures yielded actionable data when generating SD with sizes similar to the real data. Large SD sample size increased veracity but generally increased privacy risks. Using fewer training participants led to faster convergence in veracity, but partially exacerbated privacy concealment issues.

CONCLUSION

SD is a potentially promising option for data sharing and data augmentation, yet sample size plays a significant role in its actionability. SD generation should go hand-in-hand with consistent scrutiny, and sample size should be carefully considered in this process.

Sleep quality in cancer patients: a common metric for several instruments measuring sleep quality

PURPOSE

Sleep problems are frequently observed in cancer patients. Multiple questionnaires for assessing sleep quality have been developed. The aim of this study was to present transfer rules that allow the conversion of the patients' scores from one questionnaire to another. In addition, we anchored this common metric to the general population.

METHODS

A sample of 1,733 cancer patients completed the following questionnaires: Pittsburgh Sleep Quality Index, Insomnia Sleep Index, Jenkins Sleep Scale, EORTC QLQ-C30, and the sleep scale of the EORTC QLQ-SURV100. The methods for establishing a common metric were based on Item Response Theory.

RESULTS

The main result of the study is a figure that allows the conversion from one of the above-mentioned sleep scales into another. Furthermore, the scores of the questionnaires can be transferred to theta scores that indicate the position within the group of cancer patients and also to T scores that indicate the position in relation to the general population. The correlations between the sleep scales ranged between 0.70 and 0.85.

CONCLUSIONS

The conversion rules presented in the study enable researchers and clinicians to directly compare single scores or mean scores across studies using different sleep scales, to assess the degree of sleep problems with regard to the general population, and to relate cutoff scores from one questionnaire to another.

Exploring the interconnectedness between health-related quality of life factors among long-term adolescent and young adult cancer survivors (AYAs): a network analysis

PURPOSE

Adolescent and young adult cancer survivors (AYAs) are at increased risk of long-term and late effects, and experience unmet needs, impacting their health-related quality of life (HRQoL). In order to provide and optimize supportive care and targeted interventions for this unique population, it is important to study HRQoL factors' interconnectedness on a population level. Therefore, this network analysis was performed with the aim to explore the interconnectedness between HRQoL factors, in the analysis described as nodes, among long-term AYAs.

METHODS

This population-based cohort study used cross-sectional survey data of long-term AYAs, who were identified by the Netherlands Cancer Registry (NCR). Participants completed a one-time survey (SURVAYA study), including the EORTC survivorship questionnaire (QLQ-SURV111) to assess their long-term HRQoL outcomes and sociodemographic characteristics. The NCR provided the clinical data. Descriptive statistics and a network analysis, including network clustering, were performed.

RESULTS

In total, 3596 AYAs (on average 12.4 years post diagnosis) were included in our network analysis. The network was proven stable and reliable and, in total, four clusters were identified, including a worriment, daily functioning, psychological, and sexual cluster. Negative health outlook, part of the worriment cluster, was the node with the highest strength and its partial correlation with health distress was significantly different from all other partial correlations.

CONCLUSION

This study shows the results of a stable and reliable network analysis based on HRQoL data of long-term AYAs, and identified nodes, correlations, and clusters that could be intervened on to improve the HRQoL outcomes of AYAs.

A Negative Body Image among Adolescent and Young Adult (AYA) Cancer Survivors: Results from the Population-Based SURVAYA Study

Simple Summary

Adolescent and young adult (AYA) cancer survivors diagnosed with cancer between ages 18–39 years often experience negative body changes, such as scars, amputation, hair loss, disfigurement, body weight changes, skin buns, and physical movement limitations. A negative body image could have negative implications for the self-esteem, self-identity, and social relationships of AYAs. Despite the possible long-term effects of cancer on body image, within the AYA literature, limited studies focus on AYA cancer survivors in a quantitative way. Therefore, the aim of our population-based cross-sectional study was to examine the prevalence, and association of a negative body image with sociodemographic, clinical, and psychosocial factors, among AYA survivors 5–20 years after diagnosis. Raising awareness and integrating supportive care for those who experience a negative body image into standard AYA survivorship care is warranted. Future longitudinal research could help to identify when and how this support for AYA survivors can be best utilized.

Abstract

Adolescent and young adult (AYA) cancer survivors (18–39 years at diagnosis) often experience negative body changes such as scars, amputation, and disfigurement. Understanding which factors influence body image among AYA survivors can improve age-specific care in the future. Therefore, we aim to examine the prevalence, and association of a negative body image with sociodemographic, clinical, and psychosocial factors, among AYA cancer survivors (5–20 years after diagnosis). A population-based cross-sectional cohort study was conducted among AYA survivors (5–20 years after diagnosis) registered within the Netherlands Cancer Registry (NCR) (SURVAYA-study). Body image was examined via the EORTC QLQ-C30 and QLQ-SURV100. Multivariable logistic regression models were used. Among 3735 AYA survivors who responded, 14.5% (range: 2.6–44.2%), experienced a negative body image. Specifically, AYAs who are female, have a higher Body Mass Index (BMI) or tumor stage, diagnosed with breast cancer, cancer of the female genitalia, or germ cell tumors, treated with chemotherapy, using more maladaptive coping strategies, feeling sexually unattractive, and having lower scores of health-related Quality of Life (HRQoL), were more likely to experience a negative body image. Raising awareness and integrating supportive care for those who experience a negative body image into standard AYA survivorship care is warranted. Future research could help to identify when and how this support for AYA survivors can be best utilized.

[Psychosocial long-term effects of cancer]

Die Inzidenz von Krebserkrankungen hat in den westlichen Industrienationen in den letzten Jahrzehnten stetig zugenommen. Die Anzahl der Neuerkrankungen liegt in Deutschland aktuellen Schätzungen zufolge bei ca. 500.000 pro Jahr. Aufgrund der verbesserten Früherkennung sowie der Fortschritte in den Behandlungsmöglichkeiten haben sich jedoch die Überlebenszeiten bei den meisten Tumorarten erhöht. In der Folge hat auch die Zahl der Langzeitüberlebenden (≥ 5 Jahre nach Diagnose oder Ende der Behandlung) zugenommen. Trotz der Erfolge der Tumortherapie können Langzeitüberlebende von verschiedenen körperlichen oder seelischen Problemen in der Folge der Erkrankung und/oder Therapie betroffen sein. Dieser Artikel gibt einen Überblick über die psychischen Folgeprobleme, insbesondere Angst, Depression, psychosoziale Aspekte der Lebensqualität, neuropsychologische Defizite sowie Erschöpfungszustände (Fatigue). In einem abschließenden Fazit werden Empfehlungen für psychosoziale Interventionen sowie für die Verbesserung der psychosozialen Versorgung von Langzeitüberlebenden gegeben.