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Measurement Properties of the EQ-5D-5L and EQ-5D-3L in Six Commonly Diagnosed Cancers

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This study aimed to compare the measurement properties of the EQ-5D-3L (3L) and EQ-5D-5L (5L) in cancer patients.


A consecutive sample of inpatients with lung, breast, colorectal, liver, gastric, or thyroid cancer were interviewed using the 3L, 5L, and Functional Assessment of Cancer Therapy–General (FACT-G) questionnaires, and a subgroup was invited to complete the 3L and 5L again. Kappa and intraclass correlation coefficient were used to assess test–retest reliability, and Spearman’s correlation between the EQ-5D and FACT-G was evaluated to assess convergent validity. Comparison of subgroups defined using Eastern Cooperative Oncology Group status and cancer stage were performed to assess known-group validity and discriminatory power using the F-statistic and area under the receiver-operating characteristics curve. All analyses were also performed for each subgroup of cancer patients.


A total of 416 cancer patients completed the baseline questionnaire and 90 patients also completed the follow-up survey after 2 days. Ceiling effects were smaller in 5L (10.1%) than in 3L (17.8%). The test–retest reliability and convergent validity of the 5L were slightly better than those of the 3L. Both the 3L and 5L showed known-group validity; however, the 5L index showed better discriminatory power. Similar trends were found in the six types of cancers.


In general, 5L appears to have better measurement properties than 3L for measuring the health-related quality of life of cancer patients. While both the 3L and 5L are suitable, 5L should be preferable to 3L for use in cancer outcomes research.

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The authors are especially grateful to the participants who have suffered from cancer and have never given up.

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Corresponding authors

Correspondence to Weidong Huang or Hongjuan Yu.

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The current study is funded by the National Social Science Foundation of China (Grant numbers 71974048, 71503062) and the China Medical Board (CMB-19-308).

Conflict of interest

Xueyun Zeng, Mingjie Sui, Bo Liu, Hongbin Yang, Rui Liu, Rachel Lee-Yin Tan, Juan Xu, Erwei Zheng, Jinjin Yang, Chunyu Liu, Weidong Huang, Hongjuan Yu, and Nan Luo declare there are no conflicts of interest in relation to this manuscript.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards and were approved by the Regional Ethical Committee, Harbin Medical University.

Consent to participate

All individuals provided the informed consent in current study.

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Not applicable.

Availability of data and code

The data and code are available from the corresponding author upon reasonable request.

Author contributions

XZ and MS participated in the design of the study and drafted the manuscript. WH, HYu, and NL participated in the design of the study, and critically drafted and revised the manuscript. HYang, RL, EZ, JY, and CL collected and processed the data. RT helped to draft the manuscript. BL conceived the idea, and critically revised the manuscript. JX helped with data analysis and edited the revised version of the manuscript. All authors read and approved the final version of the manuscript.

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Zeng, X., Sui, M., Liu, B. et al. Measurement Properties of the EQ-5D-5L and EQ-5D-3L in Six Commonly Diagnosed Cancers. Patient 14, 209–222 (2021).

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