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International validation of the EORTC CAT Core: a new adaptive instrument for measuring core quality of life domains in cancer

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Abstract

Background

The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) has developed computerised adaptive tests (CATs) for the 14 functional and symptom domains of the EORTC QLQ-C30 quality of life questionnaire. This is expected to optimise measurement precision, relevance to patients and flexibility. Here, we present the first international validation of the EORTC CAT Core.

Methods

A heterogeneous sample of 699 cancer patients scheduled for chemotherapy and/or radiotherapy was recruited across seven European countries. The EORTC CAT Core and all QLQ-C30 items were administered to participants before and after initiating treatment. Correlations between CAT and QLQ-C30 scores and floor/ceiling effects were calculated. Using several grouping variables, relative validity (cross-sectional known groups difference), responsiveness (changes over time) and relative sample size requirements of the CAT compared to the QLQ-C30 were estimated.

Results

Correlations of the CAT and QLQ-C30 ranged from 0.81 to 0.93 across domains. The mean relative reduction in floor and ceiling effects using the CAT was 42% (range 3–99%). Analyses of known groups validity and responsiveness indicated that, across domains, mean sample size requirements for the CAT were 72% and 70%, respectively, of those using the QLQ-C30.

Conclusions

The EORTC CAT Core measures the same domains as the QLQ-C30 with reduced floor/ceiling effects. The CAT generally facilitated the use of smaller samples (about 30% smaller on average) without loss of power compared to the QLQ-C30. Based on this study, the EORTC QLG will release the EORTC CAT Core for general use.

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References

  1. Wainer, H. (2000). Computerized adaptive testing: A primer (2nd). Mahwah, New Jersey: Lawrence Erlbaum Associates Inc.

    Book  Google Scholar 

  2. Fayers, P. & on behalf of the EORTC Quality of Life Group and of the Quality of Life Unit. (2002). Quality of life research within the EORTC-the EORTC QLQ-C30. European Journal of Cancer,38(Suppl 4), S125–S133.

    Article  PubMed  Google Scholar 

  3. Petersen, M Aa, Aaronson, N. K., Arraras, J. I., Chie, W.-C., Conroy, T., Costantini, A., et al. (2018). The EORTC CAT Core—The computer adaptive version of the EORTC QLQ-C30 questionnaire. European Journal of Cancer,100, 8–16.

    Article  PubMed  Google Scholar 

  4. Dirven, L., Groenvold, M., Taphoorn, M. J. B., Conroy, T., Tomaszewski, K. A., Young, T., et al. (2017). Psychometric evaluation of an item bank for computerized adaptive testing of the EORTC QLQ-C30 cognitive functioning dimension in cancer patients. Quality of Life Research,26, 2919–2929.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dirven, L., Taphoorn, M. J., Groenvold, M., Habets, E. J. J., Aaronson, N. K., Conroy, T., et al. (2017). Development of an item bank for computerized adaptive testing of self-reported cognitive difficulty in cancer patients. Neuro-Oncology Practice,4(3), 189–196.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gamper, E. M., Groenvold, M., Petersen, M Aa, Young, T., Costantini, A., Aaronson, N., et al. (2014). The EORTC emotional functioning computer adaptive test (CAT): phase I-III of a cross-cultural item bank development. Psycho-Oncology,23, 397–403.

    Article  PubMed  Google Scholar 

  7. Gamper, E. M., Petersen, M. Aa., Aaronson, N., Costantini, A., Giesinger, J. M., Holzner, B. et al (2016). Development of an item bank for the EORTC Role Functioning Computer Adaptive Test (EORTC RF-CAT). Health Qual Life Outcomes, 14, 72

    Article  PubMed  PubMed Central  Google Scholar 

  8. Giesinger, J. M., Petersen, M. A., Groenvold, M., Aaronson, N. K., Arraras, J. I., Conroy, T., et al. (2011). Cross-cultural development of an item list for computer-adaptive testing of fatigue in oncological patients. Health Qual Life Outcomes,9(19), 19.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Petersen, M Aa, Groenvold, M., Aaronson, N. K., Chie, W.-C., Conroy, T., Costantini, A., et al. (2010). Development of computerised adaptive testing (CAT) for the EORTC QLQ-C30 dimensions—General approach and initial results for physical functioning. European Journal of Cancer,46, 1352–1358.

    Article  PubMed  Google Scholar 

  10. Petersen, M Aa, Groenvold, M., Aaronson, N. K., Chie, W.-C., Conroy, T., Costantini, A., et al. (2011). Development of computerized adaptive testing (CAT) for the EORTC QLQ-C30 physical functioning dimension. Quality of Life Research,20(4), 479–490.

    Article  PubMed  Google Scholar 

  11. Petersen, M Aa, Giesinger, J. M., Holzner, B., Arraras, J. I., Conroy, T., Gamper, E. M., et al. (2013). Psychometric evaluation of the EORTC computerized adaptive test (CAT) fatigue item pool. Quality of Life Research,22(9), 2443–2454.

    Article  PubMed  Google Scholar 

  12. Petersen, M Aa, Aaronson, N. K., Arraras, J. I., Chie, W.-C., Conroy, T., Costantini, A., et al. (2013). The EORTC computer-adaptive tests measuring physical functioning and fatigue exhibited high levels of measurement precision and efficiency. Journal of Clinical Epidemiology,66(3), 330–339.

    Article  PubMed  Google Scholar 

  13. Petersen, M Aa, Aaronson, N. K., Chie, W.-C., Conroy, T., Costantini, A., Hammerlid, E., et al. (2016). Development of an item bank for computerized adaptive test (CAT) measurement of pain. Quality of Life Research,25(1), 1–11.

    Article  PubMed  Google Scholar 

  14. Petersen, M Aa, Gamper, E. M., Costantini, A., Giesinger, J. M., Holzner, B., Johnson, C., et al. (2016). An emotional functioning item bank of 24 items for computer adaptive testing (CAT) was established. Journal of Clinical Epidemiology,70, 90–100.

    Article  PubMed  Google Scholar 

  15. Thamsborg, L. H., Petersen, M Aa, Aaronson, N. K., Chie, W.-C., Costantini, A., Holzner, B., et al. (2014). Development of a lack of appetite item bank for computer-adaptive testing (CAT). Supportive Care in Cancer,23(6), 1541–1548.

    Article  PubMed  Google Scholar 

  16. Liegl, G., Petersen, M Aa, Groenvold, M., Aaronson, N. K., Costantini, A., Fayers, P. M., et al. (2019). Establishing the European Norm for the health-related quality of life domains of the computer-adaptive test EORTC CAT Core. European Journal of Cancer,107, 133–141.

    Article  CAS  PubMed  Google Scholar 

  17. Fayers, P. M., Aaronson, N. K., Bjordal, K., Groenvold, M., Curran, D., & Bottomley, A. (2001). The EORTC QLQ-C30 scoring manual (third). Brussels: European Organisation for Research and Treatment of Cancer.

    Google Scholar 

  18. Oken, M. M., Creech, R. H., Tormey, D. C., Horton, J., Davis, T. E., McFadden, E. T., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology,5(6), 649–655.

    Article  CAS  PubMed  Google Scholar 

  19. Reise, S. P., & Revicki, D. A. (2015). Handbook of item response theory modeling: Applications to typical performance assessment. New York: Routledge.

    Google Scholar 

  20. Fayers, P. M., & Machin, D. (2016). Quality of life—The assessment, analysis and reporting of patient-reported outcomes (3rd ed.). Chichester, West Sussex: Wiley.

    Google Scholar 

  21. Jabbarian, L. J., Groenvold, M., Petersen, M Aa, Christensen, C. A., Deliens, L., van der Heide, A., et al. (2018). Assessing emotional functioning with increased power: Relative validity of a customized EORTC short form in the international ACTION Trial. Value in Health,22, 92–98.

    Article  PubMed  Google Scholar 

  22. Wilcox, R. R. (2012). Introduction to Robust Estimation and Hypothesis Testing (3rd). San Diego: Academic Press, Elsevier Inc.

    Google Scholar 

  23. The Patient-Reported Outcomes Measurement Information System (PROMIS). Retrieved October, 2019, from https://www.healthmeasures.net/explore-measurement-systems/promis.

Download references

Funding

The study was funded by the EORTC Quality of Life Group (Grant No. 007/2012 EXT). The funder had no role in the study design, data collection, analysis, interpretation or writing of the article. The executive committee of the EORTC Quality of Life Group read the article and approved it as being ‘on behalf of EORTC Quality of Life Group’. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Author information

Authors and Affiliations

  1. The Research Unit, Department of Palliative Medicine, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Bispebjerg bakke 23B, 2400, Copenhagen NV, Denmark

    Morten Aa. Petersen & Mogens Groenvold

  2. Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Neil K. Aaronson, Jacobien M. Kieffer & Marieke van Leeuwen

  3. APEMAC, EA4360 and Medical Oncology Department, Institut de cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-lès-Nancy, France

    Thierry Conroy

  4. Psychoncology Unit, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

    Anna Costantini

  5. Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Innsbruck, Austria

    Johannes M. Giesinger & Bernhard Holzner

  6. Department of Otolaryngology Head and Neck Surgery, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden

    Eva Hammerlid

  7. Surgical Unit, Faculty of Medicine, University of Southampton, Southampton, UK

    Colin D. Johnson

  8. Division of Psychosomatic Medicine, Medical Department, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany

    Sandra Nolte

  9. School of Health and Social Development, Population Health Strategic Research Centre, Deakin University, Burwood, VIC, Australia

    Sandra Nolte

  10. Department of Gastroenterology, Hampshire Hospitals NHS Trust, Kings College Hospital ENETS Centre of Excellence, Basingstoke, UK

    John K. Ramage

  11. Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland

    Krzysztof A. Tomaszewski

  12. Institute of Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany

    Annika Waldmann

  13. Hamburg Cancer Registry, Hamburg, Germany

    Annika Waldmann

  14. East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Middlesex, Northwood, UK

    Teresa Young

  15. Scientific Directorate, Centro Di Riferimento Oncologico Di Aviano (CRO) IRCCS, Aviano, Italy

    Paola Zotti

  16. Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

    Mogens Groenvold

Authors
  1. Morten Aa. Petersen
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  2. Neil K. Aaronson
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  3. Thierry Conroy
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  4. Anna Costantini
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  5. Johannes M. Giesinger
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  6. Eva Hammerlid
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  7. Bernhard Holzner
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  8. Colin D. Johnson
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  9. Jacobien M. Kieffer
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  10. Marieke van Leeuwen
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  11. Sandra Nolte
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  12. John K. Ramage
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  13. Krzysztof A. Tomaszewski
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  14. Annika Waldmann
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  15. Teresa Young
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  16. Paola Zotti
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  17. Mogens Groenvold
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Consortia

on behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group

Corresponding author

Correspondence to Morten Aa. Petersen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

The EORTC Quality of Life Group ‘s PROMs can be used free of charge in academic settings, but the group receives compensation fees when its PROMs are used in commercial settings. The CHES system for electronic data capture is developed by the commercial company Evaluation Software Development™ (ESD).

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Danish Data Protection Agency, Ref. No.: 2012-58-0004.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Petersen, M.A., Aaronson, N.K., Conroy, T. et al. International validation of the EORTC CAT Core: a new adaptive instrument for measuring core quality of life domains in cancer. Qual Life Res 29, 1405–1417 (2020). https://doi.org/10.1007/s11136-020-02421-9

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  • DOI: https://doi.org/10.1007/s11136-020-02421-9

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