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Quality of Life Research

, Volume 24, Issue 9, pp 2219–2230 | Cite as

Psychometric evaluation of the EORTC QLQ-PR25 questionnaire in assessing health-related quality of life in prostate cancer survivors: a curate’s egg

  • Eamonn O’Leary
  • Frances J. Drummond
  • Anna Gavin
  • Heather Kinnear
  • Linda SharpEmail author
Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Health-related quality of life Prostate cancer Survivors QLQ-PR25 

Notes

Acknowledgments

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.

Ethical standard

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.

References

  1. 1.
    International Agency for Research on Cancer. GLOBOCAN, 2012. Fact sheets by cancer. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed 21 Aug 2014.
  2. 2.
    Jemal, A., Center, M. M., DeSantis, C., & Ward, E. M. (2010). Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiology, Biomarkers and Prevention, 19(8), 1893–1907.PubMedCrossRefGoogle Scholar
  3. 3.
    De Angelis, R., Sant, M., Coleman, M. P., Francisci, S., Baili, P., Pierannunzio, D., et al. (2014). Cancer survival in Europe 1999–2007 by country and age: Results of EUROCARE-5—a population-based study. The lancet Oncology, 15(1), 23–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Siegel, R., DeSantis, C., Virgo, K., Stein, K., Mariotto, A., Smith, T., et al. (2012). Cancer treatment and survivorship statistics, 2012. CA: A Cancer Journal for Clinicians, 62(4), 220–241.Google Scholar
  5. 5.
    Sharp, L., Deady, S., Gallagher, P., Molcho, M., Pearce, A., Thomas, A. A., Timmons, A., & Comber, H. (2014). The magnitude and characteristics of the population of cancer survivors: Using population-based estimates of cancer prevalence to inform service planning for survivorship care. BMC Cancer, 14(1), 767.Google Scholar
  6. 6.
    Bray, F., Ren, J.-S., Masuyer, E., & Ferlay, J. (2013). Global estimates of cancer prevalence for 27 sites in the adult population in 2008. International Journal of Cancer, 132(5), 1133–1145.CrossRefGoogle Scholar
  7. 7.
    Rnic, K., Linden, W., Tudor, I., Pullmer, R., & Vodermaier, A. (2013). Measuring symptoms in localized prostate cancer: A systematic review of assessment instruments. Prostate Cancer and Prostatic Diseases, 16(2), 111–122.PubMedGoogle Scholar
  8. 8.
    Van Andel, G., Bottomley, A., Fosså, S. D., Efficace, F., Coens, C., Guerif, S., et al. (2008). An international field study of the EORTC QLQ-PR25: A questionnaire for assessing the health-related quality of life of patients with prostate cancer. European Journal of Cancer, 44(16), 2418–2424.PubMedCrossRefGoogle Scholar
  9. 9.
    Arraras, J. I., Villafranca, E., Arias de la Vega, F., Romero, P., Rico, M., Vila, M., et al. (2009). The EORTC Quality of Life Questionnaire for patients with prostate cancer: EORTC QLQ-PR25. Validation study for Spanish patients. Clinical and Translational Oncology, 11(3), 160–164.PubMedCrossRefGoogle Scholar
  10. 10.
    Chie, W.-C., Yu, C.-C., & Yu, H.-J. (2010). Reliability and validity of the Taiwan Chinese version of the EORTC QLQ-PR25 in assessing quality of life of prostate cancer patients. Urological Science, 21(3), 118–125.CrossRefGoogle Scholar
  11. 11.
    Chang, Y.-J., Liang, W.-M., Wu, H.-C., Lin, H.-C., Wang, J.-Y., Li, T.-C., et al. (2012). Psychometric evaluation of the Taiwan Chinese version of the EORTC QLQ-PR25 for HRQOL assessment in prostate cancer patients. Health and Quality of Life Outcomes, 10(1), 96.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Park, J., Shin, D. W., Yun, S. J., Park, S.-W., Jeon, S. S., Kwak, C., et al. (2013). Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer quality of life questionnaire for patients with prostate cancer-EORTC QLQ-PR25. Oncology, 85(5), 299–305.PubMedCrossRefGoogle Scholar
  13. 13.
    Denham, J. W., Wilcox, C., Lamb, D. S., Spry, N. A., Duchesne, G., Atkinson, C., et al. (2012). Rectal and urinary dysfunction in the TROG 03.04 RADAR trial for locally advanced prostate cancer. Radiotherapy and Oncology, 105(2), 184–192.PubMedCrossRefGoogle Scholar
  14. 14.
    Drummond, F.J., Kinnear, H., O’Leary, E., Donnelly, Gavin, A., & Sharp, L. (2015). Long-term health related quality of life of prostate cancer survivors varies by primary treatment. Results from the PiCTure (Prostate Cancer Treatment, your experience) study. Journal of Cancer Survivorship: Research and Practice. doi: 10.1007/s11764-014-0419-6.
  15. 15.
    Selli, C., Bjartell, A., Burgos, J., Somerville, M., Palacios, J.-M., Benjamin, L., et al. (2014). Burden of illness in prostate cancer patients with a low-to-moderate risk of progression: A one-year, pan-European observational study. Prostate Cancer, 2014, 1–8.CrossRefGoogle Scholar
  16. 16.
    Macmillan Cancer Support. Living with or beyond cancer. http://www.macmillan.org.uk/GetInvolved/Campaigns/Weareaforceforchange/Survivorship/Livingwithorbeyondcancer.aspx. Accessed 02 Feb 2015.
  17. 17.
    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
  18. 18.
    Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychology Foundation.Google Scholar
  19. 19.
    EuroQol Group. (1990). EuroQol–a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.CrossRefGoogle Scholar
  20. 20.
    Oemar, M., & Janssen, B. (2013). EQ-5D-5L user guide. Rotterdam: EuroQoL Group.Google Scholar
  21. 21.
    Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37(1), 53–72.PubMedCrossRefGoogle Scholar
  22. 22.
    Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory. New York: McGraw-Hill.Google Scholar
  23. 23.
    De Camargo Cancela, M., Comber, H., & Sharp, L. (2013). Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: A population-based study. British Journal of Cancer, 109(1), 272–279.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., et al. (2014). EAU guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent—update 2013. European Urology, 65(1), 124–137.PubMedCrossRefGoogle Scholar
  25. 25.
    Wilt, T. J., MacDonald, R., Rutks, I., Shamliyan, T. A., Taylor, B. C., & Kane, R. L. (2008). Systematic review: Comparative effectiveness and harms of treatments for clinically localized prostate cancer. Annals of Internal Medicine, 148(6), 435–448.PubMedCrossRefGoogle Scholar
  26. 26.
    Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.CrossRefGoogle Scholar
  27. 27.
    Thomas, A. A., Timmons, A., Molcho, M., Pearce, A., Gallagher, P., Butow, P., et al. (2014). Quality of life in urban and rural settings: A study of head and neck cancer survivors. Oral Oncology, 50(7), 676–682.PubMedCrossRefGoogle Scholar
  28. 28.
    Glaser, A. W., Fraser, L. K., Corner, J., Feltbower, R., Morris, E. J. A., Hartwell, G., et al. (2013). Patient-reported outcomes of cancer survivors in England 1–5 years after diagnosis: A cross-sectional survey. BMJ Open, 3(4), E002317.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Eamonn O’Leary
    • 1
  • Frances J. Drummond
    • 1
  • Anna Gavin
    • 2
  • Heather Kinnear
    • 2
  • Linda Sharp
    • 1
    • 3
    Email author
  1. 1.National Cancer RegistryCorkIreland
  2. 2.Northern Ireland Cancer RegistryBelfastUK
  3. 3.Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK

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