Psychometric evaluation of Azeri version of the head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43)

Repurposing EORTC QLQ-H&N43 and NCCN Distress Thermometer and Problem List: Adaptation and Validation in Kannada

To translate, validate and test the reliability of Kannada version of "EORTC QLQ-H&N43" and "NCCN Distress Thermometer and Problem list" version 2.2022. The English version of "EORTC QLQ H&N43" and "NCCN Distress thermometer and Problem List" version 2.2022 tools were translated into Kannada language according to standard guideline. The translated version was validated by EORTC and by using content validity index (CVI). Further, the reliability of validated tools was established via test-retest and internal consistency method whereas construct was determined via spearman rank correlation. The Cronbach alpha value > 0.7 and correlation coefficients (ρ) < 0.05 was considered as significant. The Kannada version of "EORTC QLQ-H&N43" was validated by EORTC as well as by experts whereas  NCCN distress tool was validated only by experts with average CVI score of 1 and 0.97 respectively. Out of total 80 patients, 50% were head and neck cancer (HNC) patients and 50% belonged to other cancer types. Kannada version of EORTC QLQ-H&N43 and NCCN distress tool was found to be reliable among HNC and general cancer patients respectively with the Cronbach alpha value between 0.819-1 and 0.71-1 for all the domains. Further, only 7.72% of EORTC QLQ-H&N43 and 13.33% of NCCN distress tool construct were significantly correlated with construct of EORTC QLQ-C30 (p < 0.05). The Kannada version of QoL and distress instrument was found to be valid and reliable to use among HNC and/ general cancer patients respectively. Thus, this method of translation, validation and reliability testing can be used as a novel practice in healthcare.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04366-0.

Patient-reported outcome measures for dysphagia in head and neck cancer: A systematic review and appraisal of content validity and internal structure

Dysphagia is a major head and neck cancer (HNC) issue. Dysphagia-related patient-reported outcome measures (PROMs) are critical for patient-centred assessment and intervention tailoring. This systematic review aimed to derive a comprehensive inventory of HNC dysphagia PROMs and appraise their content validity and internal structure. Six electronic databases were searched to February 2023 for studies detailing PROM content validity or internal structure. Eligible PROMs were those developed or validated for HNC, with ≥20% of items related to swallowing. Two independent raters screened citations and full-text articles. Critical appraisal followed COSMIN guidelines. Overall, 114 studies were included, yielding 39 PROMs (17 dysphagia-specific and 22 generic). Of included studies, 33 addressed PROM content validity and 78 internal structure. Of all PROMs, only the SOAL met COSMIN standards for both sufficient content validity and internal structure. Notably, the development of 18 PROMs predated the publication of COSMIN standards. In conclusion, this review identified 39 PROMs addressing dysphagia in HNC, of which only one met COSMIN quality criteria. Given that half of PROMs were developed prior to COSMIN guidelines, future application of current standards is needed to establish their psychometric quality.

Validation of Gujarati Version of European Organization for Research and Treatment of Cancer Quality of Life Modules in Head and Neck Cancer Patients of Western India

Head and neck cancer and its treatment had a significant impact on the quality of life. EORTC QLQ-C30 and EORTC QLQ-H&N35 are the two most widely used modules to assess the quality of life among head and neck cancer patients. The aim of the study is to test the reliability and validity of Gujarati version of EORTC QLQ-C30 and QLQ-H&N35module in a clinical setting. Gujarati version of EORTC QLQ-C30 and QLQ-H&N35 was administered to 400 histo-pathologically proven cases of head and neck cancer. For testing the internal consistency (reliability) Cronbach's alpha coefficient was used. The convergent and discriminant validity were explored by using Spearman's correlation coefficient test. Factor analysis was performed to obtain information about loading of the items for each scale. All most all scales of EORTC QLQ-C30 and QLQ-H&N35 showed high internal consistency having Cronbach's alpha coefficient > 0.70. Spearman's correlation coefficient ranges from -0.45 to 0.95 for EORTC QLQ-C30 and 0.42-0.94 for EORTC QLQ-H&N35 showing moderate to good convergent validity. The magnitude of the correlation of each item with its own scale exceeded the correlation with another scale confirming item discriminant validity. The factor analysis resulted in 7 and 11 different components for measuring quality of life for EORTC QLQ-C30 and QLQ-H&N35 respectively. Based on the results obtained it can be concluded that the Gujarati version of both the modules is a reliable and valid tool for measuring quality of life in head and neck cancer patients in clinical settings.

Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

Background

Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients.

Methods

In this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain.

Discussion

This study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT.

Trial registration

ClinicalTrials.gov Identifier: NCT04221165. Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00735-0.