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

Caterina Calderon, Pere J Ferrando, Urbano Lorenzo-Seva, Estrella Ferreira, Eun Mi Lee, Marta Oporto-Alonso, Berta M Obispo-Portero, Luka Mihic-Góngora, Adan Rodríguez-González, Paula Jiménez-Fonseca, Caterina Calderon, Pere J Ferrando, Urbano Lorenzo-Seva, Estrella Ferreira, Eun Mi Lee, Marta Oporto-Alonso, Berta M Obispo-Portero, Luka Mihic-Góngora, Adan Rodríguez-González, Paula Jiménez-Fonseca

Abstract

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.

Keywords: Invariance; Oncology; Psychological distress; Psychometric; Quality of life.

Conflict of interest statement

The authors have declared no conflict of interest related to this study.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Participant flow chart

References

    1. Kaasa S, Bjordal K, Aaronson N, Moum T, Wist E, Hagen S, Kvikstad A. The EORTC core quality of life questionnaire (QLQ-C30): Validity and reliability when analysed with patients treated with palliative radiotherapy. European journal of cancer. 1995;31(13):2260–2263. doi: 10.1016/0959-84049(95)00296-0.
    1. Gadisa DA, Gebremariam ET, Ali GY. 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. Health and Quality of Life Outcomes. 2019;17(1):182. doi: 10.1186/s12955-019-1257-z.
    1. Campos JADB, Spexoto MCB, da Silva WR, Serrano SV, Marôco J. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: Factorial models to Brazilian cancer patients. Einstein (São Paulo) 2018 doi: 10.1590/s1679-45082018AO4132.
    1. Davda J, Kibet H, Achieng E, Atundo L, Komen T. Assessing the acceptability, reliability, and validity of the EORTC Quality of Life Questionnaire (QLQ-C30) in Kenyan cancer patients: A cross-sectional study. Journal of Patient-Reported Outcomes. 2021;5(1):4. doi: 10.1186/s41687-020-00275-w.
    1. Nolte S, Waldmann A, Liegl G, Petersen MA, Groenvold M, Rose M. Updated EORTC QLQ-C30 general population norm data for Germany. European Journal of Cancer. 2020;137:161–170. doi: 10.1016/j.ejca.2020.06.002.
    1. Calderón C, Jiménez-Fonseca P, Hernández R, Mar Muñoz MD, Mut M, Mangas-Izquierdo M, Vicente MÁ, Ramchandani A, Carmona-Bayonas A. Quality of life, coping, and psychological and physical symptoms after surgery for non-metastatic digestive tract cancer. Surgical Oncology. 2019 doi: 10.1016/j.suronc.2019.08.009.
    1. Müller K, Karrer S, Szeimies RM, Steinbauer J, Kohl E, Steinbauer D, Zeman F, Berneburg M, Koller M. Quality of life assessment in patients with nonmelanoma skin cancer—psychometric validation of the EORTC QLQ-C30 questionnaire. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2017;15(11):1090–1100. doi: 10.1111/ddg.13357.
    1. Finck C, Barradas S, Zenger M, Hinz A. Quality of life in breast cancer patients: Associations with optimism and social support. International Journal of Clinical and Health Psychology. 2018;18(1):27–34. doi: 10.1016/j.ijchp.2017.11.002.
    1. Liegl G, Petersen MA, Groenvold M, Aaronson NK, Costantini A, Fayers PM, Holzner B, Johnson CD, Kemmler G, Tomaszewski KA, Waldmann A, Young TE, Rose M, Nolte S. Establishing the European norm for the health-related quality of life domains of the computer-adaptive test EORTC CAT core. European Journal of Cancer. 2019;107:133–141. doi: 10.1016/j.ejca.2018.11.023.
    1. Paiva CE, Carneseca EC, Barroso EM, de Camargos MG, Alfano ACC, Rugno FC, Paiva BSR. Further evaluation of the EORTC QLQ-C30 psychometric properties in a large Brazilian cancer patient cohort as a function of their educational status. Supportive Care in Cancer. 2014;22(8):2151–2160. doi: 10.1007/s00520-014-2206-3.
    1. Davudov MM, Harirchi I, Amiraliyev N, Mehtiyeva E, Mirzajani Z, Amiraliyev K, Rustamli N, Zebardast J, Montazeri A. The Azeri version of European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30): Translation and validation. Asian Pacific Journal of Cancer Prevention. 2020;21(1):267–271. doi: 10.31557/APJCP.2020.21.1.267.
    1. Silpakit C, Sirilerttrakul S, Jirajarus M, Sirisinha T, Sirachainan E, Ratanatharathorn V. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): Validation study of the Thai version. Quality of Life Research. 2006;15(1):167–172. doi: 10.1007/s11136-005-0449-7.
    1. Magaji BA, Moy FM, Roslani AC, Law CW, Sagap I. Psychometric validation of the Malaysian Chinese version of the EORTC QLQ-C30 in colorectal cancer patients. Asian Pacific Journal of Cancer Prevention. 2016;16(18):8107–8112. doi: 10.7314/APJCP.2015.16.18.8107.
    1. Calderon C, Lorenzo-Seva U, Ferrando PJ, Gómez-Sánchez D, Ferreira E, Ciria-Suarez L, Oporto-Alonso M, Fernández-Andujar M, Jiménez-Fonseca P. Psychometric properties of Spanish version of the Mini-Mental Adjustment to Cancer Scale. International Journal of Clinical and Health Psychology. 2021;21(1):100185. doi: 10.1016/j.ijchp.2020.06.001.
    1. Edwards JR, Bagozzi RP. On the nature and direction of relationships between constructs and measures. Psychological Methods. 2000;5(2):155–174. doi: 10.1037/1082-989X.5.2.155.
    1. Sánchez Pedraza R, Valderamar A. Validación para utilización en Colombia de la escala EORTC QLQ C-30 para evaluación de la calidad de vida de los pacientes con cáncer. Revista Colombiana de Cancerología. 2020;24(2):61–71. doi: 10.35509/01239015.128.
    1. Cella D, Chang C-H, Wright BD, Von Roenn JH, Skeel RT. Defining higher order dimensions of self-reported health. Evaluation & The Health Professions. 2005;28(2):122–141. doi: 10.1177/0163278705275334.
    1. Pagano I, Gotay C. Modeling quality of life in cancer patients as a unidimensional construct. Hawaii Medical Journal. 2006;65:74–82.
    1. Arraras Urdaniz JI, Villafranca Iturre E, Arias de la Vega F, Domínguez Domínguez MA, Lainez Milagro N, Manterola Burgaleta A, Martínez Lopez E, Romero Rojano P, Martínez Aguillo M. The EORTC Qualtiy of Life Questionnaire QLQ-C30 (version 3.03). Validation study for spanish prostate cancer patients. Archives Españoles de Urologia. 2008;61(8):949–954.
    1. Derogatis LR. BSI 18, brief symptom inventory 18: Administration, scoring and procedures manual. NCS Pearson Inc; 2001.
    1. Calderón C, Ferrando PJ, Lorenzo Seva U, Hernández R, Oporto-Alonso M, Jiménez Fonseca P. Factor structure and measurement invariance of the brief symptom inventory (BSI-18) in cancer patients. International Journal of Clinical And Health Psychology. 2020;20(1):71–80. doi: 10.1016/j.ijchp.2019.12.001.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology. 2008;61(4):344–349. doi: 10.1016/j.jclinepi.2007.11.008.
    1. Timmerman ME, Lorenzo-Seva U. Dimensionality assessment of ordered polytomous items with parallel analysis. Psychological Methods. 2011;16(2):209–220. doi: 10.1037/a0023353.
    1. Ferrando PJ, Lorenzo-Seva U. Assessing the quality and appropriateness of factor solutions and factor score estimates in exploratory item factor analysis. Educational and Psychological Measurement. 2018;78(5):762–780. doi: 10.1177/0013164417719308.
    1. Lorenzo-Seva U, Ferrando PJ. A general approach for fitting pure exploratory bifactor models. Multivariate Behavioral Research. 2019;54(1):15–30. doi: 10.1080/00273171.2018.1484339.
    1. Ferrando PJ, Lorenzo-Seva U. A note on improving EAP trait estimation in oblique factor-analytic and item response theory models. Psicológica. 2016;37:235–247.
    1. Ferrando, P. J., & Lorenzo-Seva, U. (2013). Unrestricted item factor analysis and some relations with item response theory. Recuperado de . 11 Nov 2021.
    1. Ferrando PJ, Lorenzo-Seva U. Exploratory item factor analysis: Additional considerations. Anales de psicología. 2014;30(3):1170–1175. doi: 10.6018/analesps.30.3.199991.
    1. Ferrando PJ, Lorenzo-seva U. Program FACTOR at 10: Origins, development and future directions. Psicothema. 2017;29(2):236–240. doi: 10.7334/psicothema2016.304.
    1. Muthén LK. Mplus user’s guide. 5. Muthén & Muthén; 2007.
    1. Ferrando PJ, Lorenzo-Seva U. The appropriateness of sum scores as estimates of factor scores in the multiple factor analysis of ordered-categorical responses. Educational and Psychological Measurement. 2021;81(2):205–228. doi: 10.1177/0013164420938108.
    1. El Alami Y, Essangri H, Majbar MA, Boutayeb S, Benamr S, El Malki HO, Souadka A. Psychometric validation of the Moroccan version of the EORTC QLQ-C30 in colorectal Cancer patients: Cross-sectional study and systematic literature review. BMC Cancer. 2021;21(1):99. doi: 10.1186/s12885-021-07793-w.
    1. Naamala A, Eriksson LE, Orem J, Nalwadda GK, Kabir ZN, Wettergren L. Psychometric properties of the EORTC QLQ-C30 in Uganda. Health and Quality of Life Outcomes. 2021;19(1):131. doi: 10.1186/s12955-021-01769-x.
    1. Gotay CC, Blaine D, Haynes SN, Holup J, Pagano IS. Assessment of quality of life in a multicultural cancer patient population. Psychological Assessment. 2002;14(4):439–450. doi: 10.1037/1040-3590.14.4.439.
    1. Van Steen K, Curran D, Kramer J, Molenberghs G, Van Vreckem A, Bottomley A, Sylvester R. Multicollinearity in prognostic factor analyses using the EORTC QLQ-C30: Identification and impact on model selection. Statistics in Medicine. 2002;21(24):3865–3884. doi: 10.1002/sim.1358.
    1. Mauer M, Bottomley A, Coens C, Gotay C. Prognostic factor analysis of health-related quality of life data in cancer: A statistical methodological evaluation. Expert Review of Pharmacoeconomics & Outcomes Research. 2008;8(2):179–196. doi: 10.1586/14737167.8.2.179.
    1. Horner-Johnson W, Suzuki R, Krahn GL, Andresen EM, Drum CE. Structure of health-related quality of life among people with and without functional limitations. Quality of Life Research. 2010;19(7):977–984. doi: 10.1007/s11136-010-9664-y.
    1. Mielenz T, Jackson E, Currey S, DeVellis R, Callahan LF. Psychometric properties of the Centers for Disease Control and Prevention Health-Related Quality of Life (CDC HRQOL) items in adults with arthritis. Health and Quality of Life Outcomes. 2006;4(1):66. doi: 10.1186/1477-7525-4-66.
    1. Sommer K, Cottone F, Aaronson NK, Fayers P, Fazi P, Rosti G, Angelucci E, Gaidano G, Venditti A, Voso MT, Baccarani M, Vignetti M, Efficace F. Consistency matters: Measurement invariance of the EORTC QLQ-C30 questionnaire in patients with hematologic malignancies. Quality of Life Research. 2020;29(3):815–823. doi: 10.1007/s11136-019-02369-5.
    1. Costa DSJ, Aaronson NK, Fayers PM, Pallant JF, Velikova G, King MT. Testing the measurement invariance of the EORTC QLQ-C30 across primary cancer sites using multi-group confirmatory factor analysis. Quality of Life Research. 2015;24(1):125–133. doi: 10.1007/s11136-014-0799-0.
    1. García-García T, Carmona-Bayonas A, Jimenez-Fonseca P, Jara C, Beato C, Castelo B, Mangas M, de Castro EM, Ramchandani A, Gomez D, Calderón C. Biopsychosocial and clinical characteristics in patients with resected breast and colon cancer at the beginning and end of adjuvant treatment. BMC Cancer. 2019 doi: 10.1186/s12885-019-6358-x.
    1. Hernández R, Calderon C, Carmona-Bayonas A, Rodríguez Capote A, Jara C, Padilla Álvarez A, Gómez-Camacho MLN, Beato C, Castelo B, Majem M, Muñoz MDM, Ivars A, Mangas-Izquierdo M, Rogado-Revuelta J, Jimenez-Fonseca P. Differences in coping strategies among young adults and the elderly with cancer. Psychogeriatrics. 2019 doi: 10.1111/psyg.12420.

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