Reliability and validity of the Amharic version of European Organization for Research and Treatment of cervical Cancer module for the assessment of health related quality of life in women with cervical cancer in Addis Ababa, Ethiopia

Pre- and Post-Treatment Quality of Life Among Patients with Advanced Stage Cervical Cancer at Tikur Anbessa Specialized Hospital, Ethiopia

Background

The development of health concepts beyond traditional markers of illness and death has made the evaluation of quality of life (QoL) crucial to patient care. Yet, there is little research evaluating the pre- and post-treatment QoL of cervical cancer survivors in Ethiopia.

Objective

This study aimed to assess the pre- and post-treatment QoL of women diagnosed with advanced-stage cervical cancer.

Methods and Materials

A cohort design was conducted at the Tikur Anbessa Specialized Hospital Oncology Center. A total of 166 cervical cancer patients were recruited consecutively. Data was collected through interviews with standardized questionnaires before and after treatment. The Wilcoxon rank test was used to assess the significant differences in pre-treatment and post-treatment quality of life. Additionally, the Mann-Whitney U-test was also employed. Statistical significance was determined with p-values <0.05 and a 95% confidence interval.

Results

Women who were in stages IVA and IVB were 24.7% and 10.2%, respectively. Both the global health scale (66.67 [47.92-75] to 83.33 [66.67-83.33]) and the functional domain QoL (66.67 [40-80] to 70 [46.67-86.66]) showed statistically significant improvements from pre-treatment to post-treatment QoL. Women under the age of 45 were found to have higher global health QOL (P < 0.001) and functional domain QOL (P = 0.029). Women presented in stages II and III had comparatively higher global health QoL (P = 0.008) and functional domain QoL (P = 0.021).

Conclusion

Global health QOL and the majority of functional quality of life significantly improved following six months of cancer treatment. But there was no discernible change in terms of sexual enjoyment, sexual function, or activity. Age, marital status, the duration since diagnosis, the stage of the cancer, and the presence of comorbidities were the factors that affected the improvement of post-treatment quality of life.

Health related quality of life and its predictive factors on cervical cancer patients in two teaching hospitals, Addis Ababa, Ethiopia

BACKGROUND

Cervical cancer is the second most prevalent and the leading cause of cancer related deaths among Ethiopian women; and about three fourth are diagnosed at advanced stages. Cervical cancer can affect the health-related quality of life (HRQOL) in multiple ways. The main aim of this study was to describe the HRQOL of cervical cancer patients and the predictive factors using validated tools.

METHODS

Institution based cross-sectional study was conducted among 264 cervical cancer patients using the validated Amharic version of European Organization for Research and Treatment of Cancer (EORTC) modules; QLQ-C30 and QLQ CX24. Descriptive statistics were used to summarize the raw data. One way ANOVA was used to determine the significance of mean differences between the dependent and independent variables. Binary and multivariable regression analysis were used to measure the association between Global Health Status and independent factors. The level of significance was set at p-value < 0.05.

RESULTS

On EORTC QLQ-C30 scales, the mean Global Health Status (GHS) was 42.57 ± 23.31. The least and highest affected functions were physical and social, mean (SD) = 76.39 ± 23.24 and 50.40 ± 32.19, respectively. The financial difficulty was the most affected among the symptom scales, 57.83 ± 35.34. Only physical function and financial difficulty have shown an independent association with GHS, (AOR = 0.21, 95% CI = 0.05-0.84), (AOR = 0.21 95% CI = 0.07-0.59), respectively. Illiterate, can read and write, were among the predictor factors that showed an independent association with the Global Health Status. Among the EORTC QLQ-CX24 symptom scales, the highest affected score was for sexual worry, mean (SD) = 51.81 + 32.197.

CONCLUSIONS

In an effort to improve the Global Health Status of cervical cancer patients in Ethiopia; physical function and financial difficulty should be the priority areas. The Illiterate and those who lack formal education need due attention in order to improve the health-related quality-of-life.

Assessing the quality of patient-reported outcome measurements for gynecological cancers: a systematic review

Purpose: To provide perspective on patient-reported outcome measurement (PROM) instruments to adopt in patients diagnosed with gynecological cancers. Methods: A systematic search was conducted to identify PROMs developed for or applied in gynecological cancer populations. PROMs identified in more than one study subsequently underwent assessment according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. Results: Overall, 55 PROMs were identified within the gynecological cancer setting, and 20 were assessed according to COSMIN guidelines. Most PROMs had limited information reported, but a best fit approach was adopted to recommend a number of instruments for use in patients with gynecological cancer. Conclusion: Further study to assess the methodological quality of each PROM utilized in gynecological cancers is warranted to endorse the recommendations of this review.

Development of the Japanese Version of the Infertility Stigma Scale: Examination of Its Reliability and Validity

The stigma of infertility negatively affects health, resulting in mental distress and poor quality of life. An appropriate scale is essential to examine the stigma experienced by infertile women and provide adequate interventions. Therefore, we developed a Japanese version of the Infertility Stigma Scale (ISS). After examining the content validity of this scale, we conducted an online survey of women undergoing fertility treatment to test the scale’s structural validity, internal consistency, intra-rater reliability, known-groups validity, convergent validity, and discriminant validity. A total of 254 participants were included in the analysis. The results of confirmatory factor analysis of four factors based on the original scale revealed the optimal fit. Cronbach’s alpha was 0.95 for the total score. Concerning test−retest analysis, the total score of the ISS and subscale had a high Spearman correlation coefficient (ρ = 0.61−0.88, p < 0.001). For convergent validity, the association between the ISS and social support, self-esteem, and family functioning was significantly negatively correlated. The results of the multitrait scaling analysis scale showed that correlations of all items exceeded 0.40, and scaling errors (7/81, 8.6%) were few. The Japanese version of the ISS was confirmed to have acceptable reliability and validity.

Anxiety and Depression in Patients with Breast Cancer: A Cross-sectional Study

BACKROUND: The early management for distress, depression, and anxiety in breast cancer patients can help improves quality of life that adherence patients to cancer treatment. AIM: This study aimed to describe the prevalence and risk factors of anxiety and depression symptomatology of breast cancer patients in the inpatients and outpatient settings. METHODS: This study used a research and development study design. The study was conducted in at the University Clinical Center of Kosovo the Medical Oncology Clinic in Pristina from August to October 2021. The total sample in this study consisted of 50 female breast cancer patients diagnosed at least 6 months before the date of assessment, aged 18 and above, able to communicate in Albanian, signed an informed consent form, negative history of other malignancies, and absence of any temporary acute illness affecting psychological well-being while filling the questionnaire. Questionnaire used in our study is Hospital Anxiety and Depression Scale for assessing anxiety and depression in breast cancer patients. RESULTS: For anxiety score, some of them were caseness level with 82%, while 26% of study participants were in borderline, 6% in caseness, and some of them were in normal level from 68% on the depression score. The patients feel tense or wound up with 44% Mean/SD (14.67 ± 6.02), about feeling afraid that something terrible will happen and patients may have this feel Mean/SD (13 ± 1.66). Over half of them had the feeling of fear as if something awful is about to happen Mean/SD (11.33 ± 4.03) and that the feeling of fear as if they had “butterflies” in the stomach of 62% had the feeling sometimes, beautiful often, and very often Mean/SD (10.33 ± 4.92). CONCLUSION: The results indicate that it is very important to measure the level of anxiety and depression in women with breast cancer, which are two common mental disorders in breast cancer.

Application of the Multidimensional Fatigue Inventory to Ethiopian Cancer Patients

Objectives: Fatigue is a frequent debilitating symptom associated with cancer. However, scientific data on cancer-related fatigue is scarce in developing nations. This work examines psychometric properties of the multidimensional fatigue inventory (MFI-20) and analyzes the level of fatigue among Ethiopian patients with cancer in comparison with data from Germany.

Methods: A sample of 256 patients with cancer drawn from a hospital in Ethiopia was examined with the MFI-20 and the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30). A comparative sample of 780 German patients with cancer served as the control.

Results: The MFI-20 scales and total score showed acceptable reliability (α = 0.60–0.93) with a considerable convergent validity between MFI-20 and the EORTC QLQ-C30 fatigue scale (r = 0.67–0.75). The Ethiopian patients with cancer reported higher levels of fatigue than the German patients. Analyses of variance showed that Ethiopian patients with cancer who were illiterate, having advanced cancer, and those who did not receive either surgery or chemotherapy reported especially high levels of fatigue.

Conclusion: The MFI-20 is a fairly reliable and valid instrument to be used with Amharic speaking patients with cancer. The high level of fatigue in these patients implies that appropriate cancer care is needed in developing countries.

Healthy-related quality of life in patients with cervical cancer in Southwest China: a cross-sectional study

Background

Cervical cancer is the second most common female malignant tumor in the world. According to a study in 2018, the incidence of cervical cancer in Yunnan Province of China was 11.42 per 100,000, the mortality rate was 3.77 per 100,000, and higher than the national average. Health-related quality of life (HRQoL) can be used not only in the selection and effect evaluation of clinical treatment plans of cervical cancer, but also in the evaluation of prognosis and long-term survival status. In this study, 288 cervical cancer patients admitted to the Yunnan Cancer Hospital in Southwest China from 2018 to 2020 were used as the survey objects to understand the HRQoL of cervical cancer patients and explore the related factors that affect HRQoL.

Methods

The Chinese version of the functional assessment of cancer therapy-cervix (functional assessment of cancer therapy-cervix v4.0, FACT-Cx V4) was used to investigate 288 patients with cervical cancer in Yunnan Province. Statistical analysis was performed using t-test, analysis of variance, multiple linear regression and other methods.

Results

The total FACT-Cx score of cervical cancer patients was (130.16 ± 14.20), the physical well-being (PWB) score was (22.02 ± 4.47), the social/family well-being (SWB) score was (25.66 ± 3.59), the emotional well-being (EWB) score was (19.75 ± 3.54), the functional well-being (FWB) score was (16.91 ± 5.01) and the additional focus area (cervical cancer subscale, CxS) score was (45.78 ± 4.61). From the multi-factor analysis results, the scores of PWB, FWB, Cxs and the total FACT-Cx were related to the choice of different treatment methods, the PWB scores of patients with concurrent chemoradiotherapy was low(β = − 1.67, P = 0.003), the FWB scores of patients with concurrent chemoradiotherapy was low(β = − 2.02, P = 0.001), the CxS scores of patients with concurrent chemoradiotherapy was low(β = − 1.61, P = 0.006), the total score of FACT-Cx of patients with concurrent chemoradiotherapy was low(β = − 5.91, P = 0.001). SWB score was affected by marital status, married patients had high PWB scores(β = 5.44, P = 0.006). The patients with heavy disease expenditures as aproportion of family disposable income(β = − 3.82, P = 0.002) and aged 60 and above(β = − 3.29, P = 0.003) had lower FWB scores. The total score FACT-Cx of patients participating in cervical cancer screening was higher(β = 7.61, P = 0.001).

Conclusion

The choice of treatment method is the common influencing factor of PWB, FWB, Cxs and the total FACT-Cx. Disease expenditures as a proportion of family disposable income, the treatment method, the marital status and whether to participate in cervical cancer screening affect the patient’s evaluation of their own HRQoL. Medical staff should pay special attention to the choice of different treatment methods, popularize vaccination knowledge and cervical cancer screening, give more humanistic care and health education to cervical cancer patients who have low education level, poor economic conditions, divorced or separated, and encourage patients to participate in active treatment to improve the health-related quality of life.

Psychometric Properties of the Quality of Life Questionnaire - Cervical Cancer 24 (QLQ CX 24) Translation to Serbian

Introduction: Cancer of the cervix has a progressive character and is one of the most significant public health problems in many countries. Our research aimed to translate EORTC QLQ CX 24 (European Organization for Research and Treatment of Cancer; Quality of life questionnaire-cervical cancer 24) from English to Serbian, to create essential cultural adaptations and to analyze psychometric properties of the translation in a model of female inpatients with cancer of the cervix. Method: The QLQ CX 24 was translated and adapted according to internationally established guidelines, and then tested on a sample of 100 Serbian females with cancer of the cervix. The testing was repeated three times on the same patients. We calculated the internal consistency (Cronbach’s alpha), criterion validity, convergent validity, and discriminative validity of the QLQ CX 24. We used factor analysis to discover the original construct. Results: The Serbian translation of QLQ CX 24 showed good internal consistency, showed satisfactory reliability, and temporal stability. In the first, when was rated by the investigators Cronbach’s alpha was 0.607, and one month later when the questionnaire also was rated by investigators Cronbach’s alpha was 0.696. When the scale was rated by females themselves Cronbach’s alpha was 0.802. Divergent as well as convergent validity tests had good results. The factorial analysis exposed six domains.Conclusion: The Serbian translation of QLQ CX 24 is a trustworthy and appropriate specific instrument for measuring the quality of life in females with cervical cancer.

The Hospital Anxiety and Depression Scale (HADS) applied to Ethiopian cancer patients

Psychological distress is a common problem associated with cancer. The main objective of the present study was to test the Hospital Anxiety and Depression Scale (HADS) in a sample of Ethiopian cancer patients and to compare the results with those obtained from a sample in Germany. Data were collected from 256 cancer patients who visited the University of Gondar Hospital between January 2019 and June 2019 using the HADS, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30), and the Multidimensional Fatigue Inventory MFI-20. The reliability of the HADS was good, with Cronbach's α coefficients of 0.86 (anxiety), 0.85 (depression), and 0.91 (total scale). The Ethiopian cancer patients were more anxious (M = 7.9) and more depressed (M = 9.3) than the German patients (M = 6.8 for anxiety and M = 5.5 for depression). Only a weak level of measurement invariance was detected between the Ethiopian and the German sample. In the Ethiopian sample, anxiety and depression were associated with tumor stage (high levels in stage 4) and treatment (high levels for patients not receiving surgery and chemotherapy). Both anxiety and depression were significantly associated with all of the EORTC QLQ-C30 and MFI-20 scales. The HADS proved to be applicable for use with Ethiopian cancer patients. The high level of anxiety and depression present in that group indicates a need for psychosocial care.

Quality of life among Ethiopian cancer patients

PURPOSE

Cancer is of increasing prevalence in less-developed countries. However, research on the patients' quality of life (QoL) in these countries is very limited. The aim of this study was to examine QoL of cancer patients in Africa.

METHOD

A sample of 256 cancer patients treated in an Ethiopian hospital was examined with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, the Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale. A group of 1664 German cancer patients served as a comparison group.

RESULTS

Most of the scales of the EORTC QLQ-C30 showed acceptable reliability in the Ethiopian sample. Compared with the German cancer patients, the Ethiopian patients showed lower QoL in most dimensions, especially in financial difficulties, physical functioning, pain, and appetite loss (effect sizes between 0.52 and 0.75). Illiteracy, tumor stage, and treatment (surgery and chemotherapy) were associated with QoL in the Ethiopian sample. QoL was strongly correlated with fatigue, anxiety, and depression.

CONCLUSION

The EORTC QLQ-C30 is a suitable instrument for measuring QoL in Ethiopia. The detriments in QoL in the Ethiopian patients indicate specific cancer care needs for the patients in a developing country.