Validation and comparative assessment of low anterior resection syndrome questionnaires in Greek rectal cancer patients

Artemis Liapi, Constantine Mavrantonis, Panagiotis Lazaridis, Eleni Kourkouni, Andreas Zevlas, George Zografos, George Theodoropoulos, Artemis Liapi, Constantine Mavrantonis, Panagiotis Lazaridis, Eleni Kourkouni, Andreas Zevlas, George Zografos, George Theodoropoulos

Abstract

Background: Our study validated the low anterior resection syndrome (LARS) score questionnaire, the colorectal functional outcome (COREFO) questionnaire, and the Memorial Sloan-Kettering Cancer Center bowel function instrument (MSKCC-BFI) in Greek rectal cancer patients.

Methods: Internal consistency, repeatability, construct and discriminant validity were evaluated for LARS, COREFO, and MSKCC-BFI questionnaires. The convergent validity was assessed by correlations with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29 domains.

Results: The internal consistency of the questionnaire's subscales was satisfactory (Cronbach's a>0.6). The repeatability test showed extremely high reproducibility (intraclass correlation coefficient >0.9). High positive correlation was detected between the 3 questionnaires' total scores and each of their questions (rho>0.5), indicating their valid construction. All questionnaires demonstrated a good convergent validity through correlations with comparable domains of the EORTC QLQ-C30 and CR29. Statistically significant associations were detected between LARS, COREFO, MSKCC-BFI scores and tumor distance and temporary stoma (P<0.001 and P=0.009, P<0.001 and P=0.005, P<0.001 and P=0.002 respectively). In addition, COREFO and MSKCC-BFI scores were significantly associated with radiation therapy. LARS score was significantly correlated to all COREFO and MSKCC-BFI subscales.

Conclusions: The Greek versions of the LARS score, COREFO and MSKCC-BFI questionnaires were proven to have good psychometric properties and can be used as specific and valid instruments for measuring LARS. Since the COREFO and MSKCC-BFI questionnaires, which are more extensive and possibly less applicable in routine clinical practice, showed no advantages in relation to the LARS score, the latter may be established as the simplest, fastest to complete and most targeted tool for assessing LARS.

Keywords: Bowel dysfunction; Memorial Sloan-Kettering Cancer Center bowel function instrument; colorectal functional outcome questionnaire; low anterior resection syndrome score; quality of life; rectal cancer.

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Flowchart of the study

References

    1. Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016):a multicentre, randomised trial. Lancet. 2009;373:811–820.
    1. van Gijn W, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer:12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12:575–582.
    1. Enker WE. Total mesorectal excision—the new golden standard of surgery for rectal cancer. Ann Med. 1997;29:127–133.
    1. Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13:e403–e408.
    1. Camilleri-Brennan J, Steele RJ. Quality of life after treatment for rectal cancer. Br J Surg. 1998;85:1036–1043.
    1. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.
    1. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44:77–80.
    1. Rockwood TH, Church JM, Fleshman JW, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence. Dis Colon Rectum. 1999;42:1525–1532.
    1. Chen TY-T, Emmertsen KJ, Laurberg S. What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Curr Colorectal Cancer Rep. 2015;11:37–43.
    1. Bakx R, Sprangers MA, Oort FJ, et al. Development and validation of a colorectal functional outcome questionnaire. Int J Colorectal Dis. 2005;20:126–136.
    1. Temple LK, Bacik J, Savatta SG, et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum. 2005;48:1353–1365.
    1. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score:development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2002;2555:922–928.
    1. Juul T, Ahlberg M, Biondo S, et al. International validation of the low anterior resection syndrome score. Ann Surg. 2014;259:728–734.
    1. Samalavicius NE, Dulskas A, Lasinskas M, Smailyte G. Validity and reliability of a Lithuanian version of low anterior resection syndrome score. Tech Coloproctol. 2016;20:215–220.
    1. Hou XT, Pang D, Lu Q, et al. Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients. Eur J Oncol Nurs. 2015;19:495–501.
    1. Juul T, Battersby NJ, Christensen P, et al. UK LARS Study Group. Validation of the English translation of the low anterior resection syndrome score. Colorectal Dis. 2015;17:908–916.
    1. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30:a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–376.
    1. Whistance RN, Conroy T, Chie W, et al. European Organisation for the Research and Treatment of Cancer Quality of Life Group. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer. 2009;45:3017–3026.
    1. World Health Organization. Process of translation and adaptation of instruments. 2010. [[Accessed 29 November, 2018]].
    1. Dewolf L, Koller M, Velikova G, Johnson C, Scott N, Bottomley A EORTC Quality of Life Group. EORTC quality of life group translation procedure. Brussels: 2009. [[Accessed 2 December, 2018]]. .
    1. Fayers P, Aaronson N. The EORTC QLQ-C30 Scoring Manual. 3rd edition. Brussels, Belgium: EORTC Data Center; 2001.
    1. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.
    1. Theodoropoulos GE, Papanikolaou IG, Karantanos T, Zografos G. Post-colectomy assessment of gastrointestinal function:a prospective study on colorectal cancer patients. Tech Coloproctol. 2013;17:525–536.
    1. Hughes DL, Cornish J, Morris C LARRIS Trial Management Group. Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome. Int J Colorectal Dis. 2017;32:691–697.
    1. Carrillo A, Enríquez-Navascués JM, Rodríguez A, et al. Incidence and characterization of the anterior resection syndrome through the use of the LARS scale (low anterior resection score) Cir Esp. 2016;94:137–143.
    1. Wells CI, Vather R, Chu MJ, Robertson JP, Bissett IP. Anterior resection syndrome—a risk factor analysis. J Gastrointest Surg. 2015;19:350–359.
    1. Ziv Y, Zbar A, Bar-Shavit Y, Igov I. Low anterior resection syndrome (LARS):cause and effect and reconstructive considerations. Tech Coloproctol. 2013;17:151–162.
    1. Visser WS, Te Riele WW, Boerma D, van Ramshorst B, van Westreenen HL. Pelvic floor rehabilitation to improve functional outcome after a low anterior resection:a systematic review. Ann Coloproctol. 2014;30:109–114.
    1. Ramage L, Qiu S, Kontovounisios C, Tekkis P, Rasheed S, Tan E. A systematic review of sacral nerve stimulation for low anterior resection syndrome. Colorectal Dis. 2015;17:762–771.

Source: PubMed

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