Abstract
BackgroundThe EORTC QLQ-C30 is one of the most widely used quality of life questionnaires in cancer research. Availability of thresholds for clinical importance for the individual questionnaire domains could help to increase its interpretability. The aim of our study was to identify thresholds for clinical importance for four EORTC QLQ-C30 scales: Physical Functioning (PF), Emotional Functioning (EF), Pain (PA) and Fatigue (FA).MethodsWe recruited adult cancer patients from Austria, the Netherlands, Poland and the UK. No restrictions were placed on diagnosis or type or stage of treatment. Patients completed the QLQ-C30 and three anchor items reflecting potential attributes of clinically important levels of PF, EF, PA and FA. We merged the anchor items assessing perceived burden, limitations in daily activities and need for help into a dichotomous external criterion to estimate thresholds for clinical importance using Receiver Operator Characteristic (ROC) analysis.ResultsIn our sample of 548 cancer patients (mean age 60.6 years; 54 % female), the QLQ-C30 scales showed high diagnostic accuracy in identifying patients reporting burden, limitations and/or need for help related to PF, EF, PA and FA. All areas under the curve were above 0.86.ConclusionsWe were able to estimate thresholds for clinical importance for four QLQ-C30 scales. When used in daily clinical practice, these thresholds can help to identify patients with clinically important problems requiring further exploration and possibly intervention by health care professionals.
Highlights
The EORTC QLQ-C30 is one of the most widely used quality of life questionnaires in cancer research
The simplest and most straight-forward approach is to rely on the wording of the item or response categories themselves, and classify a patient as having a clinically important problem if s/he responds with at least “a little” for any given item or domain assessed on the 4 point response scale (i.e. “not at all,” “a little,” “quite a bit,” and “very much”) [11, 12]
As expected, using the Threshold for Clinical Importance (TCI) definition, reflecting a higher degree of burden, limitations and need for help, we found lower prevalence rates: 41.7 % for Physical Functioning (PF), 39.2 % for FA, 28.0 % for Emotional Functioning (EF), and 24.1 % for PA
Summary
The EORTC QLQ-C30 is one of the most widely used quality of life questionnaires in cancer research. The EORTC QLQ-C30 [10] is one of the most widely used health-related quality of life (HRQOL) questionnaires in cancer research. It assesses important functioning domains (e.g. physical, emotional, role) and common cancer symptoms (e.g. fatigue, pain, nausea/vomiting, appetite loss). Reporting “quite a bit” of vomiting probably indicates a different symptom level than reporting “quite a bit” of trouble with sleeping This problem applies to studies using the same cut-off score as a threshold for all domains (e.g. a score of 50 as done by Klinkhammer et al [14])
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