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Does it matter how we evaluate HRQOL? Longitudinal comparison of the EORTC QLQ-C30/QLQ-OG25 and FACT-E

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Abstract

Purpose

To determine whether EORTC QLQ-C30/QLQ-OG25 and FACT-E compared longitudinally provide similar reflections of health-related quality of life (HRQOL).

Methods

Eighty-six esophageal cancer patients treated with curative intent, scheduled to complete both questionnaires at baseline and post-treatment time points until 36 months. A generalized estimating equation model utilizing a Gaussian family compared instruments longitudinally. The two-one-sided-test (TOST) method assessed equivalence between the instruments.

Results

Trajectories for social domain and overall quality of life differed significantly between instruments. Also, FACT-G’s functional well-being post-treatment returns to baseline 3–6 months earlier than the EORTC QLQ-C30’s role functioning subscale, suggesting measurement of different components. Trajectories for physical and esophageal symptom subscales are similar and are deemed equivalent. Emotional domains are comparable and bear little resemblance to the physical domain trajectories indicating reflection of emotional experience rather than a physical proxy. EORTC QLQ-C30 subscales have a trajectory similar to its physical functioning scale except for the emotional and esophageal symptoms scales. Overall HRQOL in both instruments showed a consistent return to baseline/pre-treatment levels by 6 months post-treatment.

Conclusions

Overall HRQOL recovers earlier after curative-intent treatment than previously reported despite persistence of physical symptoms, with a consistent return to pre-treatment levels by 6 months after treatment. This supports the concept that HRQOL is not primarily defined by physical function. Based on this longitudinal comparison, FACT-E provides a more multidimensional assessment of HRQOL.

Implications for Cancer Survivors

Curative intent treatment for esophageal cancer has adverse effects on HRQOL but despite intense treatment, overall HRQOL recovers within 6 months.

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References

  1. Darling GE. Quality of life in patients with esophageal cancer. Thorac Surg Clin. 2013;23:569–75.

    Article  Google Scholar 

  2. Hurmuzlu M, Aarstad HJ, Aarstad AKH, Hjermstad MJ, Viste A. Health-related quality of life in long-term survivors after high-dose chemoradiotherapy followed by surgery in esophageal cancer. Dis Esophagus. 2011;24(1):39–47.

    Article  CAS  Google Scholar 

  3. Lagergren J, Lagergren P. Oesophageal cancer. BMJ. 2010;341:c6280. https://doi.org/10.1136/bmj.c6280.

    Article  PubMed  Google Scholar 

  4. Lagergren J, Smyth E, Cunningham D, Lagergren P. Oesophageal cancer. Lancet. 2017;390:2383–96.

    Article  Google Scholar 

  5. Schandl A, Lagergren J, Johar A, Lagergren P. Health-related quality of life 10 years after oesophageal cancer surgery. Eur J Cancer. 2016;69:43–50.

    Article  Google Scholar 

  6. Conroy T, Marchal F, Blazeby JM. Quality of life in patients with oesophageal and gastric cancer. An overview. Oncology. 2006;70:391–402.

    Article  Google Scholar 

  7. Parameswaran R, McNair A, Avery KNL, Berrisford RG, Wajed SA, Sprangers MAG, et al. The role of health-related quality of life outcomes in clinical decision making in surgery for esophageal cancer: a systematic review. Ann Surg Oncol. 2008;15(9):2372–9.

    Article  CAS  Google Scholar 

  8. Parameswaran R, Blazeby JM, Hughes R, Mitchell K, Berrisford RG, Wajed SA. Health-related quality of life after minimally invasive oesophagectomy. Br J Surg. 2010;97(4):525–31.

    Article  CAS  Google Scholar 

  9. Whistance RN, Blazeby JM. Systematic review: quality of life after treatment for upper gastrointestinal cancer. Curr Opin Support Palliat Care. 2011;5(1):37–46.

    Article  Google Scholar 

  10. Blazeby JM, Avery K, Sprangers M, Pikhart H, Fayers D, et al. Health-related quality of life measurement in randomized clinical trials in surgical oncology. J Clin Oncol. 2006;24(19):3178–86.

    Article  Google Scholar 

  11. Efficace F, Osoba D, Gotay C, Sprangers M, Coens C, Bottomley A. Has the quality of health-related quality of life reporting in cancer clinical trials improved over time? Towards bridging the gap with clinical decision making. Ann Oncol. 2007;18(4):775–81.

    Article  CAS  Google Scholar 

  12. Reynolds JV, McLaughlin R, Moore J, Rowley S, Ravi N, Byrne PJ. Prospective evaluation of quality of life in patients with localized oesophageal cancer treated by multimodality therapy or surgery alone. Br J Surg. 2006;93(9):1084–90.

    Article  CAS  Google Scholar 

  13. Scarpa M, Valente S, Alfieri R, Cagol M, Diamantis G, Ancona E, et al. Systematic review of health-related quality of life after esophagectomy for esophageal cancer. World J Gastroenterol. 2011;17(42):4660–74.

    Article  Google Scholar 

  14. Garcia SF, Cella D, Clauser SB, Flynn KE, Lad T, et al. Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative. J Clin Oncol. 2007;25:5106–12.

    Article  Google Scholar 

  15. Trudel JG, Sulman J, Atenafu EG, Kidane B, Darling GE. Longitudinal evaluation of trial outcome index scores in patients with esophageal cancer. Ann Thorac Surg. 2016;102(1):269–75.

    Article  Google Scholar 

  16. Kidane B, Sulman J, Xu W, Kong Q, Wong R, et al. Baseline measure of health-related quality of life (functional assessment of cancer therapy-esophagus) is associated with overall survival in patients with esophageal cancer. J Thorac Cardiovasc Surg. 2016;151(6):1571–80.

    Article  Google Scholar 

  17. Kidane B, Sulman J, Xu W, Kong Q, Wong R, Knox JJ, et al. Pretreatment quality-of-life score is a better discriminator of oesophageal cancer survival than performance status. Eur J Cardiothorac Surg. 2017;51:148–54.

    Article  Google Scholar 

  18. Holzner B, Bode RK, Hahn EA, Cella D, Kopp M, Sperner-Unterweger B, et al. Equating EORTC QLQ-C30 and FACT-G scores and its use in oncological research. Eur J Cancer. 2006;42(18):3169–77.

    Article  CAS  Google Scholar 

  19. Blazeby JM, Kavadas V, Vickery CW, Greenwood R, Berrisford RG, Alderson D. A prospective comparison of quality of life measures for patients with esophageal cancer. Qual Life Res. 2005;14(2):387–93.

    Article  Google Scholar 

  20. Luckett T, King MT, Butow PN, Oguchi M, Rankin N, Price MA, et al. Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations. Ann Oncol. 2011;22(10):2179–90.

    Article  CAS  Google Scholar 

  21. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, 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(5):365–76.

    Article  CAS  Google Scholar 

  22. Blazeby JM, Alderson D, Winstone K, Steyn R, Hammerlind E, et al. Development of a EORTC questionnaire module to be used in quality of life assessment for patients with oesophageal cancer. Eur J Cancer. 1996;32A:1912–7.

    Article  CAS  Google Scholar 

  23. Lagergren P, Fayers P, Conroy T, Stein HJ, Sezer O, Hardwick R, et al. Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-OG25, to assess health-related quality of life in patients with cancer of the oesophagus, the oesophago-gastric junction and the stomach. Eur J Cancer. 2007;43(14):2066–73.

    Article  Google Scholar 

  24. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.

    Article  CAS  Google Scholar 

  25. Cella D. Manual for the functional assessment of chronic illness therapy (FACIT) measurement system. Elmhurst, Illinois : FACIT.org; 2012.

  26. Darling G, Eton DT, Sulman J, Casson AG, Cella D. Validation of the functional assessment of cancer therapy esophageal cancer subscale. Cancer. 2006;107(4):854–63.

    Article  Google Scholar 

  27. Cella D. Manual of the functional assessment of chronic illness therapy (FACIT) measurement system version 4. Evanston, Illinois: Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare and Northwestern University; 1997.

  28. Webster K, Cella D, Yost K. The functional assessment of chronic illness therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes. 2003;1:79. https://doi.org/10.1186/1477-7525-1-79.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Fayers P, Aaronson NK, Bjordal K. Sullivan K (EORTC study group on quality of life). EORTC QLQ-C30 scoring manual. Quality of Life Unit, EORTC Data Centre: Brussels; 1995.

    Google Scholar 

  30. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.

    Article  Google Scholar 

  31. Prentice RL, Zhao LP. Estimating equations for parameters in means and covariances of multivariate discrete and continuous responses. Biometrics. 1991;47:825–39.

    Article  CAS  Google Scholar 

  32. Lenth R.. emmeans: Estimated marginal means, aka least-squares means. R package version 1.4.5. 2020. https://CRAN.R-project.org/package=emmeans. Accessed 30 March 2020

  33. Statistical Analyses Software (SAS) Institute. Base SAS ® 9.3 Procedures guide. Cary, North Carolina : SAS Institute Inc; 2011.

  34. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2018. https://www.R-project.org. Accessed 30 March 2020 

  35. Hinz A, Einenkel J, Briest S, Stolzenburg J-U, Papsdorf K, et al. Is it useful to calculate sum scores of the quality of life questionnaire EORTC QLQ-C30? Eur J Cancer Care. 2012;21(5):677–83.

    Article  CAS  Google Scholar 

  36. National Center for Chronic Disease Prevention and Health Promotion | Division of Population Health, Centers Disease Control and Prevention (CDC). Health-Related Quality of Life (HRQOL). 2016. https://www.cdc.gov/hrqol/concept.htm. . Accessed 23 April 2020

  37. Ferrans CE. Definitions and conceptual models of quality of life. In: Lipscomb J, Gotay CC, Snyder C, editors. Outcomes assessment in cancer. Cambridge: Cambridge University; 2005. p. 14–30. 3.

  38. Healthy People. Foundation health measure report: health-related quality of life and well-being. Office of Disease Prevention and Health Promotion. 2020. https://www.healthypeople.gov/sites/default/files/HRQoLWBFullReport.pdf . Accessed May 15 2020.

  39. Djärv T, Lagergren P. Quality of life after esophagectomy for cancer. Expert Rev Gastroenterol Hepatol. 2012;6(1):115–22. https://doi.org/10.1586/egh.11.91.

    Article  PubMed  Google Scholar 

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Funding

We gratefully acknowledge the research support for the study from the Kress Family Esophageal Cancer Research Fund and the Kress Family Chair in Esophageal Cancer.

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Authors and Affiliations

  1. Department of Surgery, Division of Thoracic Surgery, Toronto General Hospital, University Health Network and the University of Toronto, 200 Elizabeth Street, 9N-955, Toronto, Ontario, M5G 2C4, Canada

    Gail E. Darling & Joanne Sulman

  2. Factor-Inwentash Faculty of Social Work, University of Toronto, , 246 Bloor Street W., Toronto, M5S 1V4, Canada

    Joanne Sulman

  3. Department of Biostatistics, Princess Margaret Cancer Center, University Health Network & Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Osvaldo Espin-Garcia

  4. Department of Surgery, Division of Uro-Oncology, the Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1V 4E9, Canada

    Julie G. Trudel

  5. Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Eshetu G. Atenafu

  6. Department of Surgery, Section of Thoracic Surgery, University of Manitoba and the Research Institute in Oncology & Hematology, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada

    Biniam Kidane

Authors
  1. Gail E. Darling
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  2. Joanne Sulman
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Correspondence to Gail E. Darling.

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Darling, G.E., Sulman, J., Espin-Garcia, O. et al. Does it matter how we evaluate HRQOL? Longitudinal comparison of the EORTC QLQ-C30/QLQ-OG25 and FACT-E. J Cancer Surviv 15, 641–650 (2021). https://doi.org/10.1007/s11764-020-00957-w

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