Quality of Life Research

, Volume 23, Issue 8, pp 2183–2193 | Cite as

Danish population-based reference data for the EORTC QLQ-C30: associations with gender, age and morbidity

  • Therese JuulEmail author
  • Morten Aagaard Petersen
  • Bernhard Holzner
  • Søren Laurberg
  • Peter Christensen
  • Mogens Grønvold



General population reference data are useful in the interpretation of health-related quality of life (HRQoL) results, but for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30), such data have been published for only seven countries. In 1992, Danish general population data were collected from women only for EORTC QLQ-C30 version 1. Since no Danish reference data exists for men and women for the QLQ-C30 version 3.0, the aims of this study were to generate such data and to investigate the associations between EORTC QLQ-C30 outcomes and age, gender and morbidity, as well as trends over time.


An age- and gender-stratified random sample of 3,080 Danes was drawn from the Danish Civil Registration System. The EORTC QLQ-C30 was administered electronically and by mail along with a short questionnaire concerning socio-demographics/morbidity.


Responses were obtained from 1,832 individuals (60.1 % of 3,009 eligible individuals). Response rates varied across age groups, ranging from 41.9 % (20–29 years) to 76.1 % (70–79 years). The majority of subscales were strongly associated with age and morbidity. Between genders only small, but clinically meaningful and statistically significant differences were found in five out of fifteen scales. When comparing Danish women 20 years ago and today, a tendency toward slightly improved function/reduced symptoms was observed, but the differences were small and statistically significant in only three subscales.


This study is the first to present Danish general population reference values for the EORTC QLQ-C30 version 3.0. Age and morbidity are important potential confounders that must be taken into account in HRQoL studies.


Quality of life Reference values EORTC QLQ-C30 Comorbidity Age Gender 



The authors wish to thank the Danish Cancer Research Foundation for supporting the study. The study was supported by a grant from the Danish Cancer Research Foundation. The funding source of the study had no influence on study design, data collection, data analysis, data interpretation, writing of the report or decision to submit the paper for publication.

Conflict of interest

None declared.


  1. 1.
    European Organisation for Research and Treatment of Cancer webpage. Accessed April 10 2013.
  2. 2.
    Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365–376.PubMedCrossRefGoogle Scholar
  3. 3.
    Fayers, P. M., Aaronson, N. K., Bjordal, K., Groenvold, M., Curran, D., Bottomley, A. on behalf of the EORTC quality of life group. (2001). The EORTC QLQ-C30 scoring manual (3rd ed.). Brussels: European Organisation for Research and Treatment of Cancer.Google Scholar
  4. 4.
    Bjordal, K., de Graeff, A., Fayers, P. M., Hammerlid, E., van Pottelsberghe, C., Curran, D., et al. (2000). A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. European Journal of Cancer, 36(14), 1796–1807.PubMedCrossRefGoogle Scholar
  5. 5.
    Schmidt, C. E., Bestmann, B., Kuchler, T., Longo, W. E., & Kremer, B. (2005). Impact of age on quality of life in patients with rectal cancer. World Journal of Surgery, 29(2), 190–197. doi: 10.1007/s00268-004-7556-4.PubMedCrossRefGoogle Scholar
  6. 6.
    Schmidt, C. E., Bestmann, B., Kuchler, T., Longo, W. E., Rohde, V., & Kremer, B. (2005). Gender differences in quality of life of patients with rectal cancer. A five-year prospective study. World Journal of Surgery, 29(12), 1630–1641. doi: 10.1007/s00268-005-0067-0.PubMedCrossRefGoogle Scholar
  7. 7.
    van de Poll-Franse, L. V., Mols, F., Gundy, C. M., Creutzberg, C. L., Nout, R. A., Verdonck-de Leeuw, I. M., et al. (2011). Normative data for the EORTC QLQ-C30 and EORTC-sexuality items in the general Dutch population. European Journal of Cancer, 47(5), 667–675. doi: 10.1016/j.ejca.2010.11.004.PubMedCrossRefGoogle Scholar
  8. 8.
    Michelson, H., Bolund, C., Nilsson, B., & Brandberg, Y. (2000). Health-related quality of life measured by the EORTC QLQ-C30—Reference values from a large sample of Swedish population. Acta Oncologica, 39(4), 477–484.PubMedCrossRefGoogle Scholar
  9. 9.
    Schwarz, R., & Hinz, A. (2001). Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. European Journal of Cancer, 37(11), 1345–1351.PubMedCrossRefGoogle Scholar
  10. 10.
    Hjermstad, M. J., Fayers, P. M., Bjordal, K., & Kaasa, S. (1998). Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: The QLQ = C30 (+3). Journal of Clinical Oncology, 16(3), 1188–1196.PubMedGoogle Scholar
  11. 11.
    Derogar, M., van der Schaaf, M., & Lagergren, P. (2012). Reference values for the EORTC QLQ-C30 quality of life questionnaire in a random sample of the Swedish population. Acta Oncologica, 51(1), 10–16. doi: 10.3109/0284186x.2011.614636.PubMedCrossRefGoogle Scholar
  12. 12.
    Klee, M., Groenvold, M., & Machin, D. (1997). Quality of life of Danish women: Population-based norms of the EORTC QLQ-C30. Quality of Life Research, 6(1), 27–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Finck, C., Barradas, S., Singer, S., Zenger, M., & Hinz, A. (2012). Health-related quality of life in Colombia: Reference values of the EORTC QLQ-C30. European Journal of Cancer Care (Engl), 21(6), 829–836. doi: 10.1111/ecc.12000.CrossRefGoogle Scholar
  14. 14.
    Yun, Y. H., Kim, Y. A., Min, Y. H., Chang, Y. J., Lee, J., Kim, M. S., et al. (2012). Health-related quality of life in disease-free survivors of surgically treated lung cancer compared with the general population. Annals of Surgery, 255(5), 1000–1007. doi: 10.1097/SLA.0b013e31824f1e9e.PubMedCrossRefGoogle Scholar
  15. 15.
    Park, S. Y., Bae, D. S., Nam, J. H., Park, C. T., Cho, C. H., Lee, J. M., et al. (2007). Quality of life and sexual problems in disease-free survivors of cervical cancer compared with the general population. Cancer, 110(12), 2716–2725. doi: 10.1002/cncr.23094.PubMedCrossRefGoogle Scholar
  16. 16.
    Nout, R. A., Putter, H., Jurgenliemk-Schulz, I. M., Jobsen, J. J., Lutgens, L. C., van der Steen-Banasik, E. M., et al. (2011). Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. European Journal of Cancer. doi: 10.1016/j.ejca.2011.11.014.
  17. 17.
    Kopp, I., Bauhofer, A., & Koller, M. (2004). Understanding quality of life in patients with colorectal cancer: Comparison of data from a randomised controlled trial, a population based cohort study and the norm reference population. Inflammation Research, 53(Suppl 2), S130–S135. doi: 10.1007/s00011-004-0361-6.PubMedGoogle Scholar
  18. 18.
    Hammerlid, E., & Taft, C. (2001). Health-related quality of life in long-term head and neck cancer survivors: A comparison with general population norms. British Journal of Cancer, 84(2), 149–156. doi: 10.1054/bjoc.2000.1576.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Fayers, P. M. (2001). Interpreting quality of life data: Population-based reference data for the EORTC QLQ-C30. European Journal of Cancer, 37(11), 1331–1334.PubMedCrossRefGoogle Scholar
  20. 20.
    Statistics Denmark. (2013). Accessed November 11, 2013.
  21. 21.
    Pedersen, C. B., Gotzsche, H., Moller, J. O., & Mortensen, P. B. (2006). The Danish civil registration system. A cohort of eight million persons. Danish Medical Bulletin, 53(4), 441–449.PubMedGoogle Scholar
  22. 22.
    Petersen, M. A., Groenvold, M., Aaronson, N. K., Chie, W. C., Conroy, T., Costantini, A., et al. (2010). Development of computerised adaptive testing (CAT) for the EORTC QLQ-C30 dimensions—General approach and initial results for physical functioning. European Journal of Cancer, 46(8), 1352–1358. doi: 10.1016/j.ejca.2010.02.011.PubMedCrossRefGoogle Scholar
  23. 23.
    Giesinger, J. M., Aa Petersen, M., Groenvold, M., Aaronson, N. K., Arraras, J. I., Conroy, T., et al. (2011). Cross-cultural development of an item list for computer-adaptive testing of fatigue in oncological patients. Health and Quality of Life Outcomes, 9, 19. doi: 10.1186/1477-7525-9-19.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Petersen, M. A., Groenvold, M., Aaronson, N. K., Chie, W. C., Conroy, T., Costantini, A., et al. (2011). Development of computerized adaptive testing (CAT) for the EORTC QLQ-C30 physical functioning dimension. Quality of Life Research, 20(4), 479–490. doi: 10.1007/s11136-010-9770-x.PubMedCrossRefGoogle Scholar
  25. 25.
    Petersen, M. A., Aaronson, N. K., Arraras, J. I., Chie, W. C., Conroy, T., Costantini, A., et al. (2013). The EORTC computer-adaptive tests measuring physical functioning and fatigue exhibited high levels of measurement precision and efficiency. Journal of Clinical Epidemiology, 66(3), 330–339. doi: 10.1016/j.jclinepi.2012.09.010.PubMedCrossRefGoogle Scholar
  26. 26.
    Petersen, M. A., Giesinger, J. M., Holzner, B., Arraras, J. I., Conroy, T., Gamper, E. M., et al. (2013). Psychometric evaluation of the EORTC computerized adaptive test (CAT) fatigue item pool. Quality of Life Research. doi: 10.1007/s11136-013-0372-2.
  27. 27.
    Holzner, B., Giesinger, J. M., Pinggera, J., Zugal, S., Schopf, F., Oberguggenberger, A. S., et al. (2012). The Computer-based Health Evaluation Software (CHES): A software for electronic patient-reported outcome monitoring. BMC Medical Informatics and Decision Making, 12, 126. doi: 10.1186/1472-6947-12-126.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Hjermstad, M. J., Fayers, P. M., Bjordal, K., & Kaasa, S. (1998). Using reference data on quality of life—The importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3). European Journal of Cancer, 34(9), 1381–1389.PubMedCrossRefGoogle Scholar
  29. 29.
    Giesinger, J., Kemmler, G., Mueller, V., Zabernigg, A., Mayrbaeurl, B., Thaler, J., et al. (2009). Are gender-associated differences in quality of life in colorectal cancer patients disease-specific? Quality of Life Research, 18(5), 547–555. doi: 10.1007/s11136-009-9468-0.PubMedCrossRefGoogle Scholar
  30. 30.
    Wilsnack, R. W., Wilsnack, S. C., Kristjanson, A. F., Vogeltanz-Holm, N. D., & Gmel, G. (2009). Gender and alcohol consumption: Patterns from the multinational GENACIS project. Addiction, 104(9), 1487–1500. doi: 10.1111/j.1360-0443.2009.02696.x.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    OECD. (2013). Health at a Glance, OECD indicators.  10.1787/health_glance-2013-en. Accessed March 11, 2014.
  32. 32.
    Djarv, T., Wikman, A., & Lagergren, P. (2012). Number and burden of cardiovascular diseases in relation to health-related quality of life in a cross-sectional population-based cohort study. BMJ Open, 2(5), doi: 10.1136/bmjopen-2012-001554.
  33. 33.
    Vissers, P. A., Thong, M. S., Pouwer, F., Zanders, M. M., Coebergh, J. W., & van de Poll-Franse, L. V. (2013). The impact of comorbidity on health-related quality of life among cancer survivors: Analyses of data from the PROFILES registry. Journal of Cancer Survivorship, 7(4), 602–613. doi: 10.1007/s11764-013-0299-1.PubMedCrossRefGoogle Scholar
  34. 34.
    Moro-Valdezate, D., Buch-Villa, E., Peiro, S., Morales-Monsalve, M. D., Caballero-Garate, A., Martinez-Agullo, A., et al. (2012). Factors associated with health-related quality of life in a cohort of Spanish breast cancer patients. Breast Cancer, doi: 10.1007/s12282-012-0402-x.
  35. 35.
    Klein, D., Mercier, M., Abeilard, E., Puyraveau, M., Danzon, A., Dalstein, V., et al. (2011). Long-term quality of life after breast cancer: A French registry-based controlled study. Breast Cancer Research and Treatment, 129(1), 125–134. doi: 10.1007/s10549-011-1408-3.PubMedCrossRefGoogle Scholar
  36. 36.
    Engholm, G., Ferley, J., Christensen, N., Johannesen, T., Klint, Å., Køtlum, J., et al. NORDCAN: Cancer incidence, mortality, prevalence and survival in the nordic countries, Version 5.3 (25.04.2013). Association of the Nordic Cancer Registries. Danish Cancer Society Available from Accessed December 3rd, 2013.
  37. 37.
    Gundy, C. M., & Aaronson, N. K. (2010). Effects of mode of administration (MOA) on the measurement properties of the EORTC QLQ-C30: A randomized study. Health and Quality of Life Outcomes, 8, 35. doi: 10.1186/1477-7525-8-35.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Hood, K., Robling, M., Ingledew, D., Gillespie, D., Greene, G., Ivins, R., et al. (2012). Mode of data elicitation, acquisition and response to surveys: A systematic review. Health Technology Assessment, 16(27), 1–162. doi: 10.3310/hta16270.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Therese Juul
    • 1
    Email author
  • Morten Aagaard Petersen
    • 2
  • Bernhard Holzner
    • 3
  • Søren Laurberg
    • 1
  • Peter Christensen
    • 1
  • Mogens Grønvold
    • 2
    • 4
  1. 1.Section for Colorectal and Mamma-Endocrine Surgery, Department of SurgeryAarhus University HospitalAarhusDenmark
  2. 2.The Research Unit, Department of Palliative MedicineBispebjerg University HospitalCopenhagenDenmark
  3. 3.Department of Psychiatry and PsychotherapyInnsbruck Medical UniversityInnsbruckAustria
  4. 4.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations