Psychometric properties of the EORTC QLQ-C30 in Uganda

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Abstract

Background

Self-reported measures play a crucial role in research, clinical practice and health assessment. Instruments used to assess self-reported health-related quality of life (HRQoL) need validation to ensure that they measure what they are intended to, detect true changes over time and differentiate between subjects. A generic instrument measuring HRQoL adapted for use among people living with cancer in Uganda is lacking; therefore, this study aimed to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 in patients with cancer in Uganda.

Methods

Adult patients with various types of cancer (n = 385) cared for at the Uganda Cancer Institute answered the EORTC QLQ-C30 in Luganda or English language, the two most spoken languages in the country. The two language versions were evaluated with regard to data quality (floor and ceiling effects and missing responses), reliability (internal consistency) and validity (construct, known-group and criterion). Construct validity was examined through confirmatory factor analysis (CFA). Mean scores were compared between groups differing in disease stage to assess known-group validity. Criterion validity was examined according to associations between two QLQ-C30 subscales (Global quality of life and Physical function) and the Karnofsky Performance Scale (KPS).

Results

Floor and ceiling effects were observed for several scales in the Luganda and English versions. All EORTC scales with the exception of Cognitive function (Luganda α = 0.66, English α = 0.50) had acceptable Cronbach’s alpha values (0.79–0.96). The CFA yielded good fit indices for both versions (RMSEA = 0.08, SRMR = 0.05 and CFI = 0.93). Known-group validity was demonstrated with statistically significant better HRQoL reported by patients with disease stages I–II compared to those in stages III–IV. Criterion validity was supported by positive correlations between KPS and the subscales Physical function (Luganda r = 0.75, English r = 0.76) and Global quality of life (Luganda r = 0.59, English r = 0.72).

Conclusion

The Luganda and English versions of the EORTC QLQ-C30 appear to be valid and reliable measures and can be recommended for use in clinical research to assess HRQoL in adult Ugandans with cancer. However, the cognitive scale did not reach acceptable internal consistency and needs further evaluation.

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Most cited references 26

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Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Ahmedin Jemal, Lindsey A Torre, Rebecca Siegel … (2018)

This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.

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The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

N. Aaronson, S. Ahmedzai, B Bergman … (1993)

In 1986, the European Organization for Research and Treatment of Cancer (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. We report here the results of an international field study of the practicality, reliability, and validity of the EORTC QLQ-C30, the current core questionnaire. The QLQ-C30 incorporates nine multi-item scales: five functional scales (physical, role, cognitive, emotional, and social); three symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality-of-life scale. Several single-item symptom measures are also included. The questionnaire was administered before treatment and once during treatment to 305 patients with nonresectable lung cancer from centers in 13 countries. Clinical variables assessed included disease stage, weight loss, performance status, and treatment toxicity. The average time required to complete the questionnaire was approximately 11 minutes, and most patients required no assistance. The data supported the hypothesized scale structure of the questionnaire with the exception of role functioning (work and household activities), which was also the only multi-item scale that failed to meet the minimal standards for reliability (Cronbach's alpha coefficient > or = .70) either before or during treatment. Validity was shown by three findings. First, while all interscale correlations were statistically significant, the correlation was moderate, indicating that the scales were assessing distinct components of the quality-of-life construct. Second, most of the functional and symptom measures discriminated clearly between patients differing in clinical status as defined by the Eastern Cooperative Oncology Group performance status scale, weight loss, and treatment toxicity. Third, there were statistically significant changes, in the expected direction, in physical and role functioning, global quality of life, fatigue, and nausea and vomiting, for patients whose performance status had improved or worsened during treatment. The reliability and validity of the questionnaire were highly consistent across the three language-cultural groups studied: patients from English-speaking countries, Northern Europe, and Southern Europe. These results support the EORTC QLQ-C30 as a reliable and valid measure of the quality of life of cancer patients in multicultural clinical research settings. Work is ongoing to examine the performance of the questionnaire among more heterogenous patient samples and in phase II and phase III clinical trials.

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Principles and Practice of Structural Equation Modeling, Fourth Edition

Rex B. Kline (2015)

Emphasizing concepts and rationale over mathematical minutiae, this is the most widely used, complete, and accessible structural equation modeling (SEM) text. Continuing the tradition of using real data examples from a variety of disciplines, the significantly revised fourth edition incorporates recent developments such as Pearl's graphing theory and the structural causal model (SCM), measurement invariance, and more. Readers gain a comprehensive understanding of all phases of SEM, from data collection and screening to the interpretation and reporting of the results. Learning is enhanced by exercises with answers, rules to remember, and topic boxes. The companion website supplies data, syntax, and output for the book's examples--now including files for Amos, EQS, LISREL, Mplus, Stata, and R (lavaan). New to This Edition *Extensively revised to cover important new topics: Pearl's graphing theory and the SCM, causal inference frameworks, conditional process modeling, path models for longitudinal data, item response theory, and more. *Chapters on best practices in all stages of SEM, measurement invariance in confirmatory factor analysis, and significance testing issues and bootstrapping. *Expanded coverage of psychometrics. *Additional computer tools: online files for all detailed examples, previously provided in EQS, LISREL, and Mplus, are now also given in Amos, Stata, and R (lavaan). *Reorganized to cover the specification, identification, and analysis of observed variable models separately from latent variable models. Pedagogical Features *Exercises with answers, plus end-of-chapter annotated lists of further reading. *Real examples of troublesome data, demonstrating how to handle typical problems in analyses. *Topic boxes on specialized issues, such as causes of nonpositive definite correlations. *Boxed rules to remember. *Website promoting a learn-by-doing approach, including syntax and data files for six widely used SEM computer tools.

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Author and article information

Contributors

Allen Naamala:

ORCID: http://orcid.org/0000-0001-9164-1820

namalallen@gmail.com

Lars E. Eriksson: lars.eriksson@ki.se

Jackson Orem: jackson.orem@uci.or.ug

Gorrette K. Nalwadda: gnalwadda@gmail.com

Zarina Nahar Kabir: zarina.kabir@ki.se

Lena Wettergren: lena.wettergren@ki.se

Journal

Journal ID (nlm-ta): Health Qual Life Outcomes

Journal ID (iso-abbrev): Health Qual Life Outcomes

Title: Health and Quality of Life Outcomes

Publisher: BioMed Central (London )

ISSN (Electronic): 1477-7525

Publication date (Electronic): 23 April 2021

Publication date PMC-release: 23 April 2021

Publication date Collection: 2021

Volume: 19

Electronic Location Identifier: 131

Affiliations

[1 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Department of Nursing, College of Health Sciences, , Makerere University, ; Kampala, Uganda

[2 ]Department of Medical Oncology, Uganda Cancer Institute, Kampala, Uganda

[3 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Learning, Informatics, Management and Ethics, , Karolinska Institutet, ; 171 77 Stockholm, Sweden

[4 ]GRID grid.24381.3c, ISNI 0000 0000 9241 5705, Medical Unit Infectious Diseases, , Karolinska University Hospital, ; 141 86 Stockholm, Sweden

[5 ]GRID grid.28577.3f, ISNI 0000 0004 1936 8497, School of Health Sciences, , City, University London, ; London, EC1V 0HB UK

[6 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Neurobiology, Care Sciences and Society, , Karolinska Institutet, ; Huddinge, Sweden

[7 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Women’s and Children’s Health, , Karolinska Institutet, ; Stockholm, Sweden

[8 ]GRID grid.8993.b, ISNI 0000 0004 1936 9457, Department of Public Health and Caring Sciences, , Uppsala University, ; Uppsala, Sweden

Author information

Allen Naamala http://orcid.org/0000-0001-9164-1820

Article

Publisher ID: 1769

DOI: 10.1186/s12955-021-01769-x

PMC ID: 8066473

PubMed ID: 33892718

SO-VID: efe21c71-b01c-4cee-b85e-aa28f6fef253

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 11 December 2020

Date accepted : 13 April 2021

Funding

Funded by: UCI-African Development Bank Training Scholarship

Award ID: 342/411/01

Award Recipient : Allen Naamala

Funded by: FundRef http://dx.doi.org/10.13039/501100004047, Karolinska Institutet;

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ScienceOpen disciplines: Health & Social care

Keywords: cancer,cancer care,eortc,health-related quality of life,quality of life,sub-saharan

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ScienceOpen disciplines: Health & Social care

Keywords: cancer, cancer care, eortc, health-related quality of life, quality of life, sub-saharan

Psychometric properties of the EORTC QLQ-C30 in Uganda

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Most cited references 26

Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

Principles and Practice of Structural Equation Modeling, Fourth Edition

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