Basic & Clinical Cancer Research 2017. 9(3):.

Psychometric properties of the Iranian version of colorectal cancer specific quality of life questionnaire (EORTC QLQ-CR29)
sanambar sadighi, Amir-Hosein Emami, Ali Montazeri, Mohammad-Ali Mohagheghi, Zahra Sedighi

Abstract


Background: Colorectal cancer is the third commonest cancer-related death in Iran. Since there are extensively validated modules in western countries for assessment of Health Related Quality of Life (HRQOL) measures, we selected European Organization for Research and Treatment (EORTC) C30 and EORTC QLQ CR29 to specify bowel, bladder, and sexual dysfunction of Iranian colorectal cancer patients.

Methods: A sample of 100 patients with colorectal cancer attending to Iran Cancer Institute from March 2012 to March 2013 at first line chemotherapy in the adjuvant or palliative settings participated in the study. Patients responded to the study questionnaires at the beginning and after 3-4 cycles of chemotherapies.Responses to the core questionnaire (QLQ-C30) and the QLQ-CR29 were linearly converted into 0-100 scores using standard EORTC guidelines.

Internal consistency was measured with Cronbach Alfa coefficient with estimates of a magnitude of 0.7. Correlations between the scales and single items of both the QLQ-C30 and QLQ-CR29 were examined using Pearson’s product moment correlation. Pearson’s values of greater than 0.40 were considered highly correlated. Known group comparison examined the ability of EORCT-CR29 to discriminate differences between subgroups of patients such as metastatic or local disease. Differences were assessed by Wilcoxon-Rank test. Sensitivity to changes over time was examined by response to chemotherapy in palliative or neoadjuvant settings.

Results: Females were more than males who interviewed (53%). All cases were in 22-78 years old range. Based on clinical and pathologic staging, 60% of the patients have been presented in stage IV with distant metastasis. Thirty three percent of the patients, almost all from rectal tumor group had permanent osteomy.

In assessment of QLQ-C30 core questionnaire, all of the function evaluations showed responsive positive changes over treatment. All symptom scores decreased. Only dyspnea and diarrhea had worsening with treatment. The chemotherapy protocol used for metastatic patients in this project was FOLFIRI containing irinotecan with predictable diarrhea adverse effect.

CR29 questionnaire results showed improved functioning scores during treatment and at the same time symptoms decreased.By this result, Cronbach's alpha of each aspect was in 0.48-0.77 and total Cronbach's alpha was 0.71. Stability of aspects was 0.78-0.90. Although patients with colostomy had some problem with osteomy bags, however there wasn’t a significant difference regarding fecal symptoms between patients. There weren’t significant differences between baseline and after treatment results based on patient’s age (less or more than 60 years).The present study showed internal consistency of scales, but there was differences between the lowest for blood/mucous in stool to urine incontinence and body image. The patients in early stages had significantly better results (less symptoms and better functional scales) than advanced stage patients (palliative group).

Conclusion: We found an excellent correlation between items and hypothesized sub-scales, lending support to CR-29 questionnaire construct validity. In addition, the questionnaire well discriminated patients who differed in stage and metastasis. The Iranian version of the EORTC QLQ-CR29 performed well and now could be used in outcome studies in colorectal cancer.


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