Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire

Our plain-English summary of Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire, by Ó. Arrieta, C. Núñez-Valencia, L. Reynoso-Erazo, et al (Lung Cancer, 2012).

The study

• Authors: Ó. Arrieta, C. Núñez-Valencia, L. Reynoso-Erazo, S. Alvarado, D. Flores-Estrada, L.P. Angulo, L.F. Oñate-Ocaña
• Journal: Lung Cancer
• Published: 2012;77(1):205-11
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Lung cancer (LC) is the first cause of cancer-related mortality worldwide and health-related quality of life (HRQL) is a fundamental outcome for evaluating treatment results. Our objective was to validate the Mexican-Spanish versions of the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life QLQ-LC13 disease-specific questionnaire module in Mexican patients with LC; and to explore the possible prognostic role of HRQL data.

Methods: Translation procedures followed EORTC guidelines. Both instruments were completed by patients with LC. Tests for reliability and validity were performed. A subset of patients was administered HRQL evaluations before and after chemotherapy. HRQL was associated with prognosis in chemotherapy-naïve patients. The protocol was approved by the Institute's Ethics Committee.

Results: One hundred fifty three patients (mean age, 60.3 years; 84 females and 69 males) completed both questionnaires. Compliance rates were high, and the questionnaires were well accepted. Nine of 10 multi-item scales of both questionnaires presented Cronbach's alpha coefficients > 0.7. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Patients with better Karnofsky or Eastern Cooperative Oncology Group (ECOG) performance status reported better functional HRQL scores. Different scales in the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires were accurately related with clinical characteristics. Functional as well as disease-symptom scales improved after chemotherapy, but treatment side-effects scales worsened in test-retest analysis. Better role functioning and absence of thoracic pain scales were associated with longer overall survival (OS) (p = 0.009 and p = 0.035, respectively).

Conclusion: The Mexican-Spanish versions of the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires are reliable and valid for HRQL measurement in Mexican patients with LC and can be used in clinical trials.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

In plain English

This study, from the Instituto Nacional de Cancerología (INCan) in Mexico City, tested Mexican-Spanish versions of two European quality-of-life questionnaires for people with lung cancer: the EORTC QLQ-C30 and its lung cancer module, the QLQ-LC13. It did not study asbestos exposure. Between July 2010 and February 2011, 153 outpatients completed both questionnaires. Of these, 11.8% had mesothelioma, but the article does not report their results separately. Nine of 10 multi-item scales had Cronbach's alpha above 0.70, a measure of consistency between related questions. The cognitive functioning scale was weaker. Patients with better doctor-rated performance status reported better scores on many scales. Thirty patients answered before and after two chemotherapy cycles. Their role functioning, shortness of breath and chest pain scores improved, while nausea and vomiting and hair loss worsened. In the chemotherapy-naive patients (82 of 153), better role functioning (p = 0.009) and absence of chest pain (p = 0.035) were associated with longer overall survival. The authors concluded the questionnaires are valid and reliable but should be used carefully in early lung cancer, which was under-represented.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Questionnaire translation and validation study in lung cancer outpatients, with a before-and-after (test-retest) subset and a survival analysis
• Who was studied: 153 patients (69 males; mean age 60.3 years) with histologically confirmed lung cancer attending the outpatient Thoracic Oncology Clinic at INCan, Mexico City, July 2010 to February 2011. Histology: small-cell lung cancer 5.2%, non-small-cell lung cancer 83%, mesothelioma 11.8%. 70.58% had stage IV disease. 82 were chemotherapy-naive and 30 answered again after treatment.
• Exposure: No asbestos exposure was studied. The study assessed questionnaires, not an exposure. Treatment was platin-based chemotherapy. Tobacco smoking and wood smoke exposure appear only as clinical variables linked to some questionnaire scores.
• Main results:
  • Nine of the 10 multi-item scales across both questionnaires had Cronbach's alpha above 0.70. The cognitive functioning scale had 0.60 (Table 1) and showed poor own-scale correlation.
  • Doctor-rated performance status (ECOG and Karnofsky) was associated with the Global health scale, all functional scales and several symptom scales. For example, Global health/QoL mean was 65.64 for ECOG 0,1 (n = 130) versus 47.83 for ECOG 2,3 (n = 23), p = 0.008.
  • In the test-retest subset (n = 30), after two chemotherapy courses, role functioning improved significantly (p = 0.011). Dyspnoea (p = 0.024) and chest pain (p = 0.05) improvements were described as relevant.
  • In the same test-retest subset, nausea and vomiting worsened (p = 0.020) and alopecia worsened (p = 0.001) after chemotherapy.
  • The survival analysis was done in chemotherapy-naive patients (82 of the 153 were chemotherapy-naive), according to the article's abstract.
  • Median overall survival was 11.7 months (95% CI, 9.8–13.6 months). Better role functioning (p = 0.009) and absence of thoracic pain (p = 0.035) were associated with longer overall survival. Dyspnea showed only a tendency (p = 0.06). Karnofsky Performance Status showed no association with prognosis.
  • Lower absolute lymphocyte count was associated with worse Global health/QoL, all functional scales and some symptom scales. For example, Global health/QoL mean was 57.05 with lymphocytes at or below 1.4 (n = 78) versus 68.84 at or above 1.4 (n = 73), p = 0.013.
• The authors' conclusion: The authors concluded that the Mexican-Spanish versions of the EORTC QLQ-C30 and QLQ-LC13 are valid and reliable adaptations. They added that the versions must be considered carefully in studies of early lung cancer, because that subgroup was under-represented, and that they can be widely used in clinical studies in this population.
• Limitations the authors state:
  • All patients were recruited at the outpatient clinic. Patients with very advanced disease, or on supportive palliative care without anticancer treatment, were not recruited, so none had a Karnofsky score below 60%.
  • Stage I and II patients were under-represented, so the questionnaires could perform differently in early-stage lung cancer.
  • The authors described the cognitive functioning scale as weak: it is built from only two items, and its items correlated poorly.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Quality of Life, Lung Cancer, Prognosis, Chemotherapy, Performance Status, Overall Survival, Clinical Trial.

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