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The development and validation of a quality-of-life questionnaire for head and neck cancer patients with enteral feeding tubes: the QOL-EF

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Abstract

Purpose

To develop a questionnaire that measures the impact of enteral feeding tubes (EFTs) on the quality of life (QOL) of head and neck cancer (HNC) patients

Methods

The development of the questionnaire (QOL-EF) was done in four phases. Phase 1–3 included: (1) literature review and consultation with an expert focus group (item generation), (2) pilot-testing in 12 patients and, (3) judgmental item reduction. In phase 4, the QOL-EF, FACT-H&N, and UW-QOL were administered to a cross-sectional group of HNC patients on active EFT feeding to test the reliability and validity of the QOL-EF.

Results

A 20-item QOL-EF was developed. In phase 4, 72 patients were accrued over 2.5 years, 31 of which were part of the test–retest subgroup. Cronbach’s α for the QOL-EF was 0.73, and test–retest reliability was 0.83. Moderate correlations were observed between scores for the QOL-EF and both the FACT-H&N (−0.58) and the UW-QOL (−0.42).

Conclusions

The QOL-EF is a treatment-specific QOL instrument developed and validated for use in HNC patients with EFTs. It may become an important tool in evaluating treatment outcomes and complications in these patients.

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Abbreviations

ECOG PS:

Eastern Cooperative Oncology Group performance status

EFT(s):

Enteral feeding tube(s)

FACT-G:

Functional Assessment of Cancer Therapy—General

FACT-H&N:

Functional Assessment of Cancer Therapy—Head and Neck Questionnaire

HNC:

Head and neck cancer

KPS:

Karnofsky Performance Status

QOL:

Quality of life

QOL-EF:

Quality of Life—Enteral Feeding Questionnaire

RT:

Radiotherapy

UW-QOL:

University of Washington—Quality of Life Questionnaire

References

  1. Budach W et al (2006) A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck. BMC Cancer 6:28

    Article  PubMed  CAS  Google Scholar 

  2. Pignon JP et al (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet 355(9208):949–955

    PubMed  CAS  Google Scholar 

  3. Bourhis J et al (2006) Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet 368(9538):843–854

    Article  PubMed  Google Scholar 

  4. Mekhail TM et al (2001) Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 91(9):1785–1790

    Article  PubMed  CAS  Google Scholar 

  5. Lees J (1999) Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care (Engl) 8(3):133–136

    Article  CAS  Google Scholar 

  6. van Bokhorst-de van der S et al (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86(3):519–527

    Article  Google Scholar 

  7. Zogbaum A, Fitz P, Duffy V (2004) Tube feeding may improve adherence to radiation treatment schedule in head and neck cancer. Topics Clin Nutr 19:95–106

    Google Scholar 

  8. Scolapio JS et al (2001) Prophylactic placement of gastrostomy feeding tubes before radiotherapy in patients with head and neck cancer: is it worthwhile? J Clin Gastroenterol 33(3):215–217

    Article  PubMed  CAS  Google Scholar 

  9. Raykher A et al (2007) Enteral nutrition support of head and neck cancer patients. Nutr Clin Pract 22(1):68–73

    Article  PubMed  Google Scholar 

  10. Larsson M, Hedelin B, Athlin E (2003) Lived experiences of eating problems for patients with head and neck cancer during radiotherapy. J Clin Nurs 12(4):562–570

    Article  PubMed  Google Scholar 

  11. Beaver ME et al (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125(6):645–648

    Article  PubMed  CAS  Google Scholar 

  12. Senft M et al (1993) The influence of supportive nutritional therapy via percutaneous endoscopically guided gastrostomy on the quality of life of cancer patients. Support Care Cancer 1(5):272–275

    Article  PubMed  CAS  Google Scholar 

  13. Gee L et al (2005) Associations between clinical variables and quality of life in adults with cystic fibrosis. J Cyst Fibros 4(1):59–66

    Article  PubMed  Google Scholar 

  14. Hyltander A et al (2005) Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study. Clin Gastroenterol Hepatol 3(5):466–474

    Article  PubMed  Google Scholar 

  15. Klose J et al (2003) Nutritional status and quality of life in patients with percutaneous endoscopic gastrostomy (PEG) in practice: prospective one-year follow-up. Dig Dis Sci 48(10):2057–2063

    Article  PubMed  Google Scholar 

  16. Loeser C et al (2003) Quality of life and nutritional state in patients on home enteral tube feeding. Nutrition 19(7–8):605–611

    Article  PubMed  Google Scholar 

  17. Roberge C et al (2000) Quality of life and home enteral tube feeding: a French prospective study in patients with head and neck or oesophageal cancer. Br J Cancer 82(2):263–269

    Article  PubMed  CAS  Google Scholar 

  18. Schneider SM et al (2000) Quality of life in long-term home enteral nutrition patients. Clin Nutr 19(1):23–28

    Article  PubMed  CAS  Google Scholar 

  19. Van Bokhorst-de Van der Schuer MA et al (2000) Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial. Clin Nutr 19(6):437–444

  20. Verhoef MJ, Van Rosendaal GM (2001) Patient outcomes related to percutaneous endoscopic gastrostomy placement. J Clin Gastroenterol 32(1):49–53

    Article  PubMed  CAS  Google Scholar 

  21. Weaver JP, Odell P, Nelson C (1993) Evaluation of the benefits of gastric tube feeding in an elderly population. Arch Fam Med 2(9):953–956

    Article  PubMed  CAS  Google Scholar 

  22. Bannerman E et al (2000) A cross-sectional and longitudinal study of health-related quality of life after percutaneous gastrostomy. Eur J Gastroenterol Hepatol 12(10):1101–1109

    Article  PubMed  CAS  Google Scholar 

  23. Cella DF et al (1993) The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol 11(3):570–579

    PubMed  CAS  Google Scholar 

  24. List MA et al (1996) The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy-head and neck scale. A study of utility and validity. Cancer 77(11):2294–2301

    Article  PubMed  CAS  Google Scholar 

  25. United Nations Human Settlements Programme (2004) The state of the world's cities, 2004/2005: globalization and urban culture. Earthscan, London, xviii, 198 p

  26. Hassan SJ, Weymuller EA Jr (1993) Assessment of quality of life in head and neck cancer patients. Head Neck 15(6):485–496

    Article  PubMed  CAS  Google Scholar 

  27. Karnofsky D et al (1948) The use of nitrogen mustards in the palliative treatment of cancer. Cancer 1:634–656

    Article  Google Scholar 

  28. Oken MM et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655

    Article  PubMed  CAS  Google Scholar 

  29. Nunnally J (1978) Psychometric theory. McGraw Hill, New York, p 245–246

  30. Weiner E, Stewart B. (1984) Assessing individuals: psychological and educational tests and measurements. Little Brown, Boston, p 68–69

  31. Rosenthal DI, Lewin JS, Eisbruch A (2006) Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 24(17):2636–2643

    Article  PubMed  Google Scholar 

  32. Ringash J et al (2008) Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: quality of life in a prospective phase I/II trial. Radiother Oncol 87(2):181–187

    Article  PubMed  Google Scholar 

  33. Waldron J et al (2008) A dose escalation study of hyperfractionated accelerated radiation delivered with integrated neck surgery (HARDWINS) for the management of advanced head and neck cancer. Radiother Oncol 87(2):173–180

    Article  PubMed  Google Scholar 

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Supported by: Canadian Foundation for Dietetic Research Practice-Based Research Grant

Conflicts of interest

None declared

Author information

Authors and Affiliations

  1. University of Toronto, Toronto, Ontario, Canada

    Christiaan Seimeon Michael Stevens, John N. Waldron, Andrea Bezjak & Jolie Ringash

  2. Department of Radiation Oncology Princess Margaret Hospital, University Health Network and University of Toronto, 610 University Ave., Toronto, Ontario, Canada, M5G 2M9

    Christiaan Seimeon Michael Stevens, John N. Waldron, Andrea Bezjak & Jolie Ringash

  3. Clinical Nutrition, Allied Health Services, Princess Margaret Hospital, University Health Network, 610 University Ave., Toronto, Ontario, Canada, M5G 2M9

    Betty Lemon

  4. Department of Biostatistics, Princess Margaret Hospital, University Health Network, 610 University Ave., Toronto, Ontario, Canada, M5G 2M9

    Gina A. Lockwood

Authors
  1. Christiaan Seimeon Michael Stevens
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  2. Betty Lemon
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  3. Gina A. Lockwood
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  4. John N. Waldron
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  5. Andrea Bezjak
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  6. Jolie Ringash
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Corresponding author

Correspondence to Jolie Ringash.

Additional information

Betty Lemon is now a retired practitioner.

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Stevens, C.S.M., Lemon, B., Lockwood, G.A. et al. The development and validation of a quality-of-life questionnaire for head and neck cancer patients with enteral feeding tubes: the QOL-EF. Support Care Cancer 19, 1175–1182 (2011). https://doi.org/10.1007/s00520-010-0934-6

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  • DOI: https://doi.org/10.1007/s00520-010-0934-6

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