Quality of Life Research

, Volume 13, Issue 4, pp 725–733 | Cite as

Interpreting differences in quality of life: The FACT-H&N in laryngeal cancer patients

  • Jolie Ringash
  • Andrea Bezjak
  • Brian O'Sullivan
  • Donald A. Redelmeier


Quality of life (QOL) scores can be difficult to interpret, because small statistically significant differences can be clinically unimportant. Our goal was to estimate the magnitude of difference in QOL that is noticeable to patients. Methods: Laryngeal cancer patients (n = 98, male = 83%, mean age = 65) completed a QOL questionnaire, FACT-H&N. Paired participants rated their own QOL as compared to each other. We estimated the smallest difference in QOL score that was associated with a noticeable difference in patients' subjective ratings. Results: Differences in FACT-H&N score were somewhat correlated with patients' ratings of their well-being relative to other patients (r= 0.195, p < 0.0001). The FACT-H&N score had to differ by 6.22 for patients to rate themselves as ‘a little bit better’ relative to other patients (95% CI: 1.42–11.02), and by 12.40 for patients to rate themselves as ‘a little bit worse’ relative to others (95% CI: 5.09–19.71). Results were consistent regardless of patient age, gender or laryngeal subsite but were imperfect predictors of individual judgements. Conclusion: The minimal important difference for the FACT-H&N score is about 6–12 units, but laryngeal cancer survivors may be more sensitive to gains than losses.

Laryngeal neoplasms Minimal important difference Quality of life Questionnaires 


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  1. 1.
    National Cancer Institute of Canada. Canadian Cancer Statistics 1997. National Cancer Institute of Canada, 1997.Google Scholar
  2. 2.
    Sobin LH, Wittekind Ch, eds. International Union Against Cancer TNM Classification of Malignant Tumours. 5th ed. New York: John Wiley & Sons, 1997: 33-37.Google Scholar
  3. 3.
    Finizia C, Geterud A, Holmberg E, et al. Advanced laryngeal cancer T3-T4 in Sweden: A retrospective study (1986–1990) — survival and locoregional control related to treatment. Acta Otolaryngol (Stockh) 1996; 116: 906-912.Google Scholar
  4. 4.
    Forestiere AA, Berkey B, Maor M, et al. Phase III trial to preserve the larynx: Induction chemotherapy and radiotherapy versus concomitant chemoradiotherapy versus radiotherapy alone, Intergroup trial R91-11 [abst]. Proc Am Soc Clin Oncol (ASCO), San Francisco; J Clin Oncol 2001; 20: 2a.Google Scholar
  5. 5.
    The Department of Veterans' Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991; 324: 1685-1690.Google Scholar
  6. 6.
    Guyatt GH, Feeny D, Patrick D. Proceedings of the international conference on the measurement of quality of life as an outcome in clinical trials: Postscript. Controlled Clin Trials 1991; 12: 266S-269S.Google Scholar
  7. 7.
    Liang MH. Evaluating measurement responsiveness. J Rheumatol 1995; 22: 1191-1192.Google Scholar
  8. 8.
    Lydick E, Epstein RS. Interpretation of quality of life changes. Qual Life Res 1993; 2: 221-226.Google Scholar
  9. 9.
    Jaeschke R, Singer J, Guyatt GH. Measurement of Health Status: Ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10: 407-415.Google Scholar
  10. 10.
    Wright JG. The minimal important difference: Who's to say what is important? J Clin Epidemiol 1996; 49: 1221-1222.Google Scholar
  11. 11.
    Ringash J, Bezjak A. A structured review of quality of life instruments for head and neck cancer patients. Head Neck 2001; 23: 201-213.Google Scholar
  12. 12.
    D'Antonio LL, Zimmerman GJ, Cella DF, et al. Quality of life and functional status measures in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 1996; 122: 482-487.Google Scholar
  13. 13.
    Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy scale: Development and validation of the general measure. J Clin Oncol 1993; 11(3): 570-579.Google Scholar
  14. 14.
    Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM (ed.), Evaluation of Chemotherapeutic Agents. New York: Columbia University Press, 1949: 191-205.Google Scholar
  15. 15.
    Redelmeier DA, Guyatt GH, Goldstein RS. Assessing the minimal important difference in symptoms: A comparison of two techniques. J Clin Epidemiol 1996; 49: 1215-1219.Google Scholar
  16. 16.
    Juniper EF, Guyatt GH, Willan A, et al. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994; 47: 81-87.Google Scholar
  17. 17.
    Osoba D, Rodrigues G, Myles J, et al. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998; 16: 139-144.Google Scholar
  18. 18.
    Redelmeier DA, Lorig K. Assessing the clinical importance of symptomatic improvements: An illustration in rheumatology. Arch Intern Med 1993; 153: 1337-1342.Google Scholar
  19. 19.
    Wells GA, Tugwell P, Kraag GR, et al. Minimum important difference between patients with rheumatoid arthritis: The patient's perspective. J Rheumatol 1993; 20: 557-560.Google Scholar
  20. 20.
    Redelmeier DA, Goldstein RS, Min ST, et al. Spirometry and dyspnea in patients with COPD: when small differences mean little. Chest 1996; 109: 1163-1168.Google Scholar
  21. 21.
    Redelmeier DA, Bayoumi AM, Goldstein RS, et al. Interpreting small differences in functional status: The six minute walk test in chronic lung disease patients. Am J Respir Crit Care Med 1997; 155: 1278-1282.Google Scholar
  22. 22.
    Moses LE. Think and Explain with Statistics. Reading, Massachusetts: Addison Wesley 1986: 336-338.Google Scholar
  23. 23.
    Ringash J, Redelmeier D, O'Sullivan B, Bezjak A. Quality of life and utility in irradiated laryngeal cancer patients. Int J Rad Onc Biol Phys 2000; 47: 875-881.Google Scholar
  24. 24.
    List MA, D'Antonio LL, Cella DF, et al. The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy — Head and Neck scale. Cancer 1996; 77: 2294-2301.Google Scholar
  25. 25.
    Cella D, Hahn EA, Dineen K. Meaningful change in cancer-specific quality of life scores: Differences between improvement and worsening. Qual Life Res 2002; 11: 207-221.Google Scholar
  26. 26.
    Cella DF. Manual of the Functional Assessment of Chronic Illness Therapy (FACIT) Scales. Centre on Outcomes, Research and Education (CORE), Evanston: Northwestern Healthcare and Northwestern University, 1997.Google Scholar
  27. 27.
    Brant R, Sutherland L, Hilsden R. Examing the minimum important difference. Stat Med 1999; 18: 2593-2603.Google Scholar
  28. 28.
    Weinstein ND. Optimistic biases about personal risks. Science 1989; 246: 1232-1233.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Jolie Ringash
    • 1
    • 3
  • Andrea Bezjak
    • 1
    • 3
  • Brian O'Sullivan
    • 1
    • 3
  • Donald A. Redelmeier
    • 2
    • 3
  1. 1.Department of Radiation Oncology, Princess Margaret HospitalUniversity Health NetworkTorontoCanada
  2. 2.Sunnybrook & Women's Hospital and the Institute for Clinical Evaluative SciencesTorontoCanada
  3. 3.University of TorontoTorontoCanada

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