Comparing translations of the EORTC QLQ-C30 using differential item functioning analyses

The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is one of the most widely used quality of life instruments for cancer patients. The aim of this study was to assess whether there were linguistic differences in the way an international sample answered the EORTC QLQ-C30 questionnaire. Thirteen translations of the EORTC QLQ-C30, representing 22 countries, were investigated using a database of 27,891 respondents, incorporating 103 separate studies. Differential item functioning (DIF) analyses were conducted using logistic regression to identify items which, after controlling for subscale, were answered differently by language of administration. Both uniform and non-uniform DIF were assessed. Although most languages showed similar results to English, at least one instance of statistically significant DIF was identified for each translation, and a few of these differences were large. In some cases, the patterns were supported by the results of qualitative interviews with bilingual people. Although, overall, there appeared to be good linguistic equivalence for most of the EORTC QLQ-C30 items, several scales showed strongly discrepant results for some translations. Some of these effects are large enough to impact on the results of clinical trials. Based on our experience in this study, we suggest that validation of translations of health-related quality of life instruments should include exploration of DIF.     

Anxiety, depression and quality of life in colorectal cancer patients

Background Few studies have examined psychological distress and its relationship with quality of life (QL) dimensions in colorectal cancer patients. Methods One hundred and twenty-eight outpatients were given psychological tests for anxiety and depression (Hospital Anxiety and Depression Scale; HADS) and QL The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ-C30) on the same occasion. The association between the patients' emotional function (EF) scoring on EORTC QLQ-C30 and their HADS scores was analyzed by multiple linear regression. Results Statistically significant negative relationships were found between EF and HADS-A (anxiety), HADS-D (depression), and HADS-T (total score), respectively, with the highest correlation coefficient being for HADS-A. However, HADS-D was significantly more highly correlated than HADS-A to other QL dimensions, and depression was more highly correlated than anxiety with reduced QL. Conclusion The EF dimension of the EORTC QLQ-C30 predominantly assesses anxiety. Depression has a stronger impact on the global QL of patients than anxiety; therefore, the use of an additional instrument is recommended for the assessment of depression in outpatients with colorectal cancer.     

Assessment of quality of life of nasopharyngeal carcinoma patients with EORTC QLQ-C30 and H&N-35 modules

PURPOSE: The current study reports on long-term quality of life (QoL) status after conventional radiotherapy in 187 nasopharyngeal carcinoma patients from 14 centers in Turkey. PATIENTS AND METHODS: Patients with the diagnosis of nasopharyngeal carcinoma, who were treated in 14 centers in Turkey with minimum 6 months of follow-up and were in complete remission, were asked to complete Turkish versions of EORTC QLQ-C30 questionnaire and the HN-35 module. Each center participated with the required clinical data that included age at diagnosis, gender, symptoms on admission, follow-up period, treatment modalities, radiotherapy dose, and AJCC 1997 tumor stage. Each patient's 33 QoL scores, which included function, global health status, and symptoms, were calculated as instructed in EORTC QLQ-C30 scoring manual. All of the scales and single-item measures range from 0 to 100. A high score represents a higher response level. Kruskal-Wallis and Mann-Whitney U nonparametric tests were used for comparisons. RESULTS: One hundred eighty-seven patients with median age of 46 years (range, 16-79 years) participated and completed the questionnaires. Median follow-up time was 3.4 years (range, 6 months-24 years). All patients have received external-beam radiotherapy. Beside external-beam radiotherapy, 59 patients underwent brachytherapy boost, 70 patients received concomitant chemotherapy, and 95 patients received adjuvant/neoadjuvant chemotherapy. Most of the patients in the analysis (75%) were in advanced stage (Stage III, n = 85 [45.4%]; Stage IV, n = 55 [29%]). Mean global health status was calculated as 73. Parameters that increased global health status were male gender, early-stage disease, and less than 4-year follow-up (p < 0.05). Functional parameters were better in males and in early-stage disease. Factors that yielded better symptom scores were short interval after treatment (10 scores), male gender (7 scores), and lower radiation dose (6 scores). Neoadjuvant or adjuvant chemotherapy did not have any effect on QoL, whereas concomitant chemotherapy adversely affected 5 symptom scores. CONCLUSION: Quality of life is adversely affected in our nasopharyngeal carcinoma patients treated with combined therapies. The factors that adversely affect quality of life are advanced tumor stage, female gender, and long-term follow-up. Further controlled studies to evaluate both preradiotherapy and postradiotherapy status are necessary to clarify the contribution of each treatment modality to QoL.     

Quality of life and Its Determinants among Cervical Cancer Patients in South India

Introduction: Cervical Cancer is the leading cause of morbidity and mortality in India. It affects the patient’s, physical and psychological state which results in lower quality of life (QoL). Women with cervical cancer may require counselling and time to enable them to deal with the disease and its treatment. The present study aimed to determine the quality of life and its determinants among cervical cancer patients. Methods: A cross-sectional study was undertaken from April 2017 to September 2017 in a regional cancer centre in South India. Cervical cancer patients (N= 210) with histological confirmation were interviewed at the hospital. European Organization of Research and Treatment of Cancer (EORTC) questionnaire core module, QLQ-C30 Version 3.0, and recommended scoring algorithm were used to measure and analyse QoL. The Association of socio-economic determinants on quality of life was evaluated using multiple logistic regression. Results: Among 210 cervical cancer patients enrolled, the majority 106 (50.5%) of women were between the age group 46 to 59 years and most, i.e.  167(63.0%) were not literate. The median score in the global health status was 50.0[IQR 33.3 – 66.7], 66.7[IQR 60.0 – 80.0] in physical functioning, and 83.3[IQR 66.7 – 83.3] in pain symptoms respectively which were poor compared to reference score of EORTC for all normal females and those with any cancer. The factors which were significantly associated with the GHS QoL score were the advanced stage of disease (OR:2.1, 95%CI: 1.1 – 3.9) and the age of the patients ≥60 years compared with ≤ 45 years (OR:18.4, 95%CI: 6.8 – 50.1). Conclusion: Cervical cancer patients had poor global health status compared to the reference score for all females with any cancer and the normal females. Advanced stage of cancer and older age have a significant association with QoL.     

Validity of the Greek EORTC QLQ‐C30 and QLQ‐BR23 for measuring health‐related quality of life in breast cancer patients

KONTODIMOPOULOS N., NTINOULIS K. & NIAKAS D. (2011) European Journal of Cancer Care 20 , 354–361
Validity of the Greek EORTC QLQ‐C30 and QLQ‐BR23 for measuring health‐related quality of life in breast cancer patients The aim of this study was to assess construct validity and internal consistency reliability of the Greek EORTC QLQ‐C30 and QLQ‐BR23 instruments. A sample of female breast cancer patients (n= 105) were self‐administered the QLQ‐C30, QLQ‐BR23 and SF‐36 and questions on treatment and socio‐demographic status. Hypothesised scale structure, reliability (Cronbach's α) and construct validity (convergent, discriminative, concurrent and known‐groups) were assessed. Multitrait scaling confirmed scale structure of the QLQ‐C30 and QLQ‐BR23 with good item convergence (92% and 85%), and discrimination (87% and 84%) rates. Cronbach's α was >0.70 for all but one scale (cognitive functioning). Strength of Spearman's correlations between the QLQ‐C30 and SF‐36 scales assessing similar health‐related quality of life dimensions ranged from 0.25 to 0.64 (P < 0.01). Construct validity was confirmed with satisfactory results for interscale correlations and known‐groups comparisons. QLQ‐BR23 scales showed comparatively low (<0.40) correlations with QLQ‐C30 functional scales, and higher correlations with conceptually related symptom scales. Most QLQ‐C30 and QLQ‐BR23 scales discriminated between pre‐treatment and current treatment patients. The overall psychometric results for the Greek version of the QLQ‐C30 and QLQ‐BR23 confirmed it as a reliable and valid questionnaire for assessing breast cancer‐specific HRQoL in Greece.     

Psychometric Validation of the Bahasa Malaysia Version of the EORTC QLQ-CR29

Background: This study examined the psychometric properties of the Bahasa Malaysia (BM) version of the European Organization for Research and Treatment of Cancer (EORTC) Colorectal Cancer-specific Quality Of Life Questionnaire (QLQ-CR29). Materials and Methods: We studied 93 patients recruited from University Malaya and Universiti Kebangsaan Medical Centers, Kuala Lumpur, Malaysia using a self-administered method. Tools included QLQ-C30, QLQ-CR29 and Karnofsky Performance Scales (KPS). Statistical analyses included Cronbach’s alpha, test-retest correlations, multi-traits scaling and known-groups comparisons. A p value ≤ 0.05 was considered significant. Results: The internal consistency coefficients for body image, urinary frequency, blood and mucus and stool frequency scales were acceptable (Cronbach’s alpha α ≥ 0.65). However, the coefficients were low for the blood and mucus and stool frequency scales in patients with a stoma bag (α = 0.46). Test-retest correlation coefficients were moderate to high (range: r = 0.51 to 1.00) for most of the scales except anxiety, urinary frequency, buttock pain, hair loss, stoma care related problems, and dyspareunia (r ≤ 0.49). Convergent and discriminant validities were achieved in all scales. Patients with a stoma reported significantly higher symptoms of blood and mucus in the stool, flatulence, faecal incontinence, sore skin, and embarrassment due to the frequent need to change the stoma bag (p < 0.05) compared to patients without stoma. None of the scales distinguished between patients based on the KPS scores. There were no overlaps between scales in the QLQ-C30 and QLQ-CR29 (r < 0.40). Conclusions: the BM version of the QLQ CR29 indicated acceptable psychometric properties in most of the scales similar to original validation study. This questionnaire could be used to complement the QLQ-C30 in assessing HRQOL among BM speaking population with colorectal cancer.     

Evaluation of the EORTC QLQ-C30 questionnaire: A comparison with SF-36 Health Survey in a cohort of Italian long-survival cancer patients

Background: Despite the large amount of data available about the EORTCQLQ-C30 questionnaire, there have been very few studies focussed onlong-survival cancer patients, and no data are available on its performancein the Italian setting.Patients and methods: Within the framework of a project aimed atevaluating the characteristics of available HR-QOL questionnaires in theItalian language, the EORTC QLQ-C30 questionnaire together with the ShortForm 36-item Health Survey (SF-36) were mail-administered to a sample ofpatients previously recruited in two large multicenter randomized clinicaltrials on early breast and colon cancers. The properties of thequestionnaire were evaluated using standard psychometric techniques andcorrelation analyses with demographic and clinical independent variables.Results: In the sample of patients who sent back the questionnaires underevaluation, the EORTC QLQ-C30 showed satisfactory acceptability (responserate = 64% and very low prevalence of missing at item and scalelevel), and the psychometric analyses confirmed the multi-dimensionalconceptualisation in terms of convergent and discriminant validity.Moreover, EORTC QLQ-C30 scales showed substantial correlation with thehomologous SF-36 scales. Few socio-demographic (age, gender, schooling) andclinical (type of cancer disease) variables were associated with HR-QOL.Breast cancer patients reported, on average, worse physical health-relatedscores, but after adjustment for age and education, most of the differencesdisappeared.Conclusions: These findings confirm the validity and robustness of theEORTC QLQ-C30 in this sample of long-survival Italian cancer patients. Furtherad hoc validation studies are required to evaluate its significance in theseparticular patients.     

Validation of the Japanese version of EORTC QLQ-CR38

Purpose The objective of this study was to test the reliability and validity of the Japanese version of the European Organization for Research and Treatment of Cancer (EORTC) Colorectal Cancer-Specific Quality of Life Questionnaire (QLQ-CR38). Methods The questionnaire was tested among 109 colorectal cancer patients on several occasions. The timing was prior to treatment with radiotherapy or chemotherapy, during treatment and 3 months following the second assessment. For purpose of test–retest reliability, a subgroup of patients completed the QLQ-CR38 1 week following the third assessment. Results Multitrait scaling analysis confirmed the hypothesised scale structure of both the function scales and the symptom scales except female sexual problem scale. Cronbach’s alpha coefficients for seven of the nine scales exceeded the 0.7 criterion at one or both assessments. The test–retest reliability for all scales except three symptom scales was 0.67 or higher. On the basis of known-groups comparisons, four of 46 comparisons distinguished between patients differing in disease stage, initial and on-treatment performance status and presence or absence of a stoma. Additionally, these scales detected change over time as a function of change in performance status and treatment-induced change. Conclusion These preliminary results suggest that the Japanese EORTC QLQ-CR38 may be a reliable and valid supplementary measure of quality of life in colorectal cancer patients.     

Management of sporadic desmoid-type fibromatosis: A European consensus approach based on patients’ and professionals’ expertise – A Sarcoma Patients EuroNet and European Organisation for Research and Treatment of Cancer/Soft Tissue and Bone Sarcoma Group initiative

Desmoid-type fibromatosis (DF) is a rare monoclonal, fibroblastic proliferation characterised by a variable and often unpredictable clinical course. It may affect nearly all parts of the body including extremities, trunk and abdomen. Considering the variable clinical presentations, anatomic locations and biological behaviours, an individualised treatment approach is required. No established or evidence-based approach for the treatment of this neoplasm is available as of today. Therefore, we propose a consensus treatment algorithm based on a round table meeting bringing together sarcoma experts from the European Organisation for Research and Treatment of Cancer (EORTC) Soft Tissue and Bone Sarcoma Group (STBSG) with patient advocates from Sarcoma Patients EuroNet (SPAEN). The aim of the meeting was to develop – for the first time ever – a consensus approach based on professionals’ AND patients’ expertise. As a fundamental prerequisite, all patients should be discussed in a multidisciplinary setting in centres or professional networks with a specific expertise in the disease.