Supportive Care in Cancer

, Volume 26, Issue 9, pp 3063–3071 | Cite as

Impact of reconceptualization response shift on rating of quality of life over time among people with advanced cancer

  • Ala’ S. Aburub
  • B. Gagnon
  • S. Ahmed
  • A. M. Rodríguez
  • Nancy E. Mayo
Original Article



People with cancer may experience change in what constitutes quality of life (QOL) over time as a result of the cancer progression (true change) or adaptation to the experience, considered as a response shift phenomenon. As individualized measures are ideally suited to explore response shift, this study aimed to estimate the extent to which reconceptualization response shift occurred over time in a cancer population and the impact of this response shift on estimates of change on QOL measures.


Ninety-seven people with advanced cancer completed the study measures including the Patient-Generated Index (PGI) at diagnosis (T0) and 1 year later (T1). The response shift indicator was the change in the number of areas nominated (range − 4 to + 3). Multivariate linear regression was used to estimate the effect of changing areas on change in the PGI score, single indicators of global QOL, and the EQ-5Dindex adjusted for age and sex.


Approximately 72% of people in this sample either added or dropped areas over time. People who dropped more than two areas had higher PGI scores at T1 than T0 while people who added areas showed low PGI score.


The results are consistent with the PGI framework as areas nominated tend to focus on negative aspects of QOL.


Response shift Reconceptualization Individualized measures Patient-Generated Index (PGI) Quality of life 


Funding information

This research was supported by a grant from the Terry Fox Research Institute and by the Cancer Research Society/Rob Lutterman Pancreatic Cancer Research Grant. B Gagnon is a recipient of “Chercheur-clinicien Boursier” award from Fond de Recherche Santé Québec, Québec, Canada.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ala’ S. Aburub
    • 1
  • B. Gagnon
    • 2
  • S. Ahmed
    • 3
  • A. M. Rodríguez
    • 4
  • Nancy E. Mayo
    • 5
  1. 1.School of Physical and Occupational Therapy, Division of Clinical Epidemiology, Royal Victoria Hospital SiteMcGill UniversityMontrealCanada
  2. 2.Département de médecine familiale et de médecine d’urgence, Centre de Recherche sur le Cancer, Centre de recherche du CHU de QuébecUniversite LavalQuébecCanada
  3. 3.School of Physical and Occupation Therapy, Division of Clinical Epidemiology, Centre de recherche interdisciplinaire réadaptation (CRIR) constance Lethbridge rehabilitaion CenterMcGill University Health CentreMontrealCanada
  4. 4.School of Rehabilitation SciencesMcGill UniversityMontrealCanada
  5. 5.Division of Clinical Epidemiology, Royal Victoria Hospital SiteMcGill University Health CenterMontrealCanada

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