The current use of the EORTC QLQ-NMIBC24 and QLQ-BLM30 questionnaires for the assessment of health-related quality of life in bladder cancer patients: a systematic review

PURPOSE

Investigating the use of the EORTC bladder cancer (BC) modules by evaluating: (a) study contexts/designs; (b) languages/countries in which the modules were administered; (c) their acceptance by patients/investigators; and (d) their psychometric properties.

METHODS

A systematic review was performed with studies from 1998 until 20/10/2021 in five databases. Articles/conference abstracts using the EORTC-QLQBLM30 (muscle invasive BC) and the EORTC-QLQNMIBC24 (previously referred to as QLQ-BLS24; non-muscle invasive BC) were included. Two authors independently screened titles/abstracts/full-texts and performed data extraction.

RESULTS

A total of 76 eligible studies were identified. Most studies included the BLM30 (n = 53), were in a urological surgery context (n = 41) and were cross-sectional (n = 35) or prospective (n = 30) in design. The BC modules were administered in 14 languages across 19 countries. Missing data were low-moderate for all non-sex related questions (< 1% to 15%). Sex-related questions had higher rates of missing data (ranging from 6.9% to 84%). Most investigators did not use all scales of the questionnaires. One validation study for the original BLS24 led to the development of the NMIBC24, which adopted a new scale structure for which good structural validity was confirmed (n = 3). Good reliability and validity was shown for the NMIBC24 module, except for malaise and bloating/flatulence scales. Psychometric evidence for BLM30 is lacking.

CONCLUSION

These results provide insight into how the EORTC BC quality of life modules could be further improved. Current work is ongoing to update the modules and to determine if the two modules can be combined into a single questionnaire that works well in both the NMIBC and MIBC settings.

Use of NHS Direct calls for surveillance of influenza--a second year's experience

A second year's call data to NHS Direct are presented to evaluate their usefulness for influenza surveillance. During the winter of 2000-01, age-group-specific data relating to the 'cold/flu' algorithm were collected from six NHS Direct sites (population coverage: 16 million). The total number of calls was collected from all 23 NHS Direct sites on a daily basis. Despite the winter of 2000-01 having been a season of low activity for influenza in the United Kingdom, NHS Direct data demonstrated a peak in the 'cold/flu' calls as a proportion of the total calls (3.1% [672 'cold/flu' calls] during week 06/01). This coincided with the peak recorded by routine influenza surveillance systems. There was also an earlier peak in the proportion of 'cold/flu' calls (3.3% during weeks 52/00 [789 'cold/flu' calls] and 01/01 [749 'cold/flu' calls]) which may have been due to other respiratory infections, the lack of specificity of the definition of NHS Direct 'cold/flu' calls and an increase in 'out-of-hours' calls to NHS Direct at the time. Despite limitations, the timeliness of NHS Direct data, the total population coverage of the service and the ability to provide local information on 'cold/flu' calls make the call data suitable for further surveillance during the winter of 2001-02. It is hoped that as NHS Direct reaches a 'steady state' in terms of population coverage and uniformity of clinical support systems, it will be possible to begin to construct 'baselines' for the respiratory disease related call data.

Can calls to NHS Direct be used for syndromic surveillance?

This study assessed whether NHS Direct could be a useful source of surveillance data for communicable diseases, using influenza as a pilot condition. Data on the weekly total number of calls and the number from people reporting influenza-like symptoms to three pilot NHS Direct sites were collected between November 1999 and March 2000. NHS Direct data were compared with routinely available influenza surveillance data. The NHS Direct call rate peaked at 331 per 100,000 population in week 52 of 1999. The percentage of calls for 'influenza-like illness' (one site) peaked at 15% during week 51. Information about weekly call numbers to NHS Direct could be produced in a timely way. It was not clear whether the observed peak in calls reflected a true increase in influenza or whether it was the result of an increase in calls over the Christmas/Millennium holiday period due to more difficulty in accessing other services. The ability to assess the proportion of calls made directly by, or on behalf of, each age group will be of vital importance in interpreting seasonal respiratory disease.