Psychometric evaluation of the EORTC QLQ-PR25 questionnaire in assessing health-related quality of life in prostate cancer survivors: a curate’s egg
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The EORTC QLQ-PR25 was primarily developed to measure disease-specific health-related quality of life (HRQoL) of prostate cancer (PCa) patients undergoing active treatment. The growing number of cancer survivors has focussed interest on assessing survivors’ HRQoL. We evaluated psychometric properties of the EORTC QLQ-PR25 questionnaire amongst PCa survivors.
A postal questionnaire, including the QLQ-PR25, was administered to 6559 PCa survivors 2–18 years post-diagnosis, identified through population-based cancer registries in Ireland; 3348 participated. The QLQ-PR25 has been suggested to have five multi-item subscales measuring urinary (US), bowel (BS) and hormone treatment-related symptoms (TS), sexual activity (SA) and sexual functioning (SF), and a single item measuring bother due to using incontinence aids (IA). Reliability analysis, divergent validity, discriminant validity (compared to EORTC QLQ-C30, DASS-21 and EuroQoL EQ-5D-5L), and exploratory and confirmatory factor analysis (EFA, CFA) were undertaken.
The percentage of survivors completing QLQ-PR25 subscales was: US-79 %; IA-20 %; BS-83 %; TS-86 %; SA-87 %; and SF-26 %. Reliability was acceptable (Cronbach’s α > 0.7) for three subscales (US, SA, SF). The instrument discriminated well between clinically distinct groups, especially those defined by primary treatment(s) and stage at diagnosis. The SA and SF subscales showed good discriminant validity compared to QLQ-C30, DASS-21 and EQ-5D-5L; other subscales did not. EFA reproduced a near fit to the proposed factor structure. CFA confirmed this.
This is the largest ever QLQ-PR25 validation study. When used in PCa survivors, although the proposed factor structure was confirmed, some of the subscales (e.g. BS and TS) showed poor reliability, a lack of discriminant validity and moderate levels of item non-response.
KeywordsHealth-related quality of life Prostate cancer Survivors QLQ-PR25
The study was funded by grants from the Health Research Board (HRA_HSR/2010/17) and Prostate Cancer UK (NI09-03). The National Cancer Control Programme in the Republic of Ireland provided additional support for analysis. The National Cancer Registry Ireland is funded by the Department of Health and the Northern Ireland Cancer Registry by the Public Health Agency Northern Ireland. The authors thank the health care professionals who facilitated and supported the study; the members of Men Against Cancer (MAC) who assisted with survey testing; Joanne Clooney, Claire O’Callaghan and Audrey Craven-Lynn (NICR) for survey administration and clerical support; Patricia McDowell and Jonathan Mitchell for data entry; Sandra Deady and Colin Fox for provision of cancer registration data; the tumour registration officers and data and IT staff in the two registries who collected and processed the cancer registrations; and the men who complete the survey.
Conflict of interest
LS received an unrestricted project grant in 2011–2012 from Sanofi-Aventis to investigate comorbidity, treatment and survival in prostate cancer. None of the other authors have any conflicts of interest to declare.
The study was approved by the Irish College of General Practitioners, for RoI, and the Office for Research Ethics Committee Northern Ireland. Participants provided informed consent.
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