Quality-of-life measurement in patients undergoing radiation therapy for head and neck cancer: a Hong Kong experience.
ABSTRACT The aims of this study are (1) to establish a reliable and valid quality-of-life (QOL) questionnaire for Chinese patients with head and neck (H&N) cancer who are treated with radiation therapy and (2) to evaluate the impact of the immediate side effects of treatment on the QOL of these patients. The 39-item "Quality of Life Radiation Therapy Instrument with Head and Neck Companion Module" (QOL-RTI/H&N) was translated into Chinese. In the reliability evaluation phase (study module 1), the questionnaire was administered twice to 56 H&N cancer patients, 7 days apart, during the second and third week of radiation therapy. In the validity evaluation phase (study module 2), 138 patients completed the QOL-RTI/H&N before starting and at the end of radiation therapy. Sixty-nine of these 138 patients also completed the QOL-RTI/H&N during the second week of their radiation therapy, at the same time as completing the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaire. Cronbach alpha coefficients were 0.88 for the general-tool QOL-RTI and 0.90 for the H&N subscale. Test-retest reliability was satisfactory with intraclass correlation coefficients of 0.89 for the general-tool QOL-RTI and 0.75 for the H&N subscale. The instrument can discriminate between patients with stage I or II disease and those with stage III or IV disease (P < .05). Concurrent validity was established by the good agreement with the FACT-H&N (r = 0.86, P < .001). A highly significant deterioration was in the QOL from the baseline to the end of treatment (mean difference for general tool = 1.95, P < .001; mean difference for H&N subscale = 4.85, P < .001). The Chinese QOL-RTI/H&N is a reliable and valid tool for determining the QOL in H&N cancer patients receiving radiation therapy. The immediate side effects of treatment had a significantly negative impact on the patients' QOL. The impact was relatively large for the functional and treatment-site aspects.
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ABSTRACT: We aimed to develop a quality-of-life subscale for nasopharyngeal carcinoma (NPC) and validate the functional assessment of cancer therapy-nasopharyngeal (FACT-NP). The FACT-NP was tested cross-sectionally in survivors of postirradiated NPC (n = 357) and was administered to newly diagnosed patients (n = 160) before, at the end of, and 3 months after radiotherapy (RT). Each FACT-NP domain was internally consistent (Cronbach's alpha = 0.87-0.90). The test-retest reliability for each subscale was satisfactory (intraclass correlation coefficient = .73-.88). Concurrent validity was suggested by the moderate to strong correlations between the FACT-NP and the Quality of Life-Radiation Therapy Instrument-Head and Neck (QOL-RTI-H&N) subscales (Pearson r = .39-.84). The FACT-NP was responsive to clinical changes from pretreatment to 3 months after RT (effect sizes > 0.6 for clinically relevant subscales). The pooled data for multitrait scaling analysis showed satisfactory item internal consistency and item discriminant validity (100% and 90% scaling success, respectively). The FACT-NP is a reliable and valid instrument for measuring QOL in patients with NPC.Head & Neck 03/2009; 31(6):738-47. · 2.83 Impact Factor
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ABSTRACT: To translate and validate the Chinese version of the Quality Of Life Radiation Therapy Instrument and the Head & Neck Module (QOL-RTI/H&N), a disease-specific scale to measure quality of life (QOL) for patients with head and neck cancer (HNC) who received radiotherapy. The QOL-RTI/H&N was translated and validated according to the standard process: a translation and back-translation procedure, pilot testing and a validation study. HNC patients were enrolled from the Cancer Center of Sun Yat-sen University and assessed using the QOL-RTI/H&N, QLQ-C30 and QLQ-H&N35. Reliability (internal consistency reliability, split-half reliability and test-retest reliability), validity (content validity, construct validity, criterion validity and discriminant validity), and responsiveness analysis were performed to evaluate the psychometric characteristics of the QOL-RTI/H&N. A total of 238 patients (99.2%) completed the questionnaire. Item RTI23 had 16.0% missing data. Other items had low percentages of missing data (0.4% or 0.8%) or no missing data. The average time to finish the scale was 9.8 minutes. Cronbach's alpha of the domains ranged from 0.41 to 0.77. The split-half reliability coefficients ranged from 0.43 to 0.77. All of the intra-class correlation coefficients were equal to or greater than 0.8. All of the item-own domain correlation coefficients were greater than those of the item-other domain. Confirmatory factor analysis showed that Comparative Fit Index, Normed Fit Index and Non-Normed Fit Index were equal to 1.00. Root Mean Square Error of Approximation was 0.01, with 90% CI (0.00, 0.10). The domain scores of the QOL-RTI/H&N were significantly correlated with those of the QLQ-C30 or QLQ-H&N3. All domain scores of patients in different radiotherapy stages were statistically significant (P < 0.05), apart from the speech domain. The Chinese version of the QOL-RTI/H&N is a valid, reliable and responsive scale to measure QOL in HNC patients and can be used to assess the effects of radiotherapy treatment on these patients.Health and Quality of Life Outcomes 04/2014; 12(1):51. · 2.27 Impact Factor
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ABSTRACT: The objective of this explorative study was to measure weight loss during radiotherapy and to select predictive factors for early identification of malnourished patients. One hundred and fifty-nine consecutive initial diagnosed nasopharyngeal carcinoma patients attending the Oncology Center at Qilu Hospital of Shandong University, China participated. Patients' weights were measured at the baseline visit and at the end of radiotherapy. The baseline characteristics were recorded. A stepwise linear regression analysis was performed to find association between baseline characteristics and malnutrition. At baseline, 56% of the patients already had a 5% weight loss during the last 3 mo; after the treatment, the median weight loss was 6.9 kg (range, 2.1-12.6 kg). After the multivariate linear regression analyses, the following factors turned out to be independent prognostic factors for significant weight loss: global quality of life, body mass index, N stage, insomnia, radiation techniques, Karnofsky performance status, concurrent chemotherapy, and fatigue. The authors conclude that severe weight loss during radiotherapy for nasopharyngeal carcinoma is common. A combination of clinical factors may lead to malnutrition for nasopharyngeal carcinoma during radiotherapy.Nutrition and Cancer 06/2011; 63(6):873-9. · 2.70 Impact Factor