kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.3.150 kjhp-15-150 Original Article A Comparative Study on the Assessment of the Quality of Life by Older Cancer Patients and Caregivers and Assessment of Performance Status by Medical Staff ChoiKyoungwon 1 BaeHoonsik 2 LimYeon Ok 3 NamIlsung 3 YoonHyunsook 1 KimYojin 1 LeeHyen Joo 4 Department of Social Welfare, Graduate School of Hallym University, Chuncheon, Korea Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea Hallym University Institute of Aging, Chuncheon, Korea Department of Social Welfare, Hallym Polytechnic University, Chuncheon, Korea ￭ Corresponding author：Hoonsik Bae, MD, PhD Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: +82-33-248-1760, Fax: +82-33-256-3424 E-mail: b8510@hallym.or.kr 122015 19122015 153 150159 20012015 10072015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The study examined the correlations among the results of the European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Questionnaire, Core 30 (QLQ-C30) completed by elderly cancer patients and their family caregivers and the Eastern Cooperative Oncology Group (ECOG)-performance status (PS) evaluated by medical doctors.

 Methods

The study sample included 269 persons with cancer aged 55 years or older and their family care-givers recruited from hospitals located in Seoul and Gyeonggi-do. The results of the ECOG-PS evaluated by medical doctors were obtained from medical records. Intra-class correlation analysis was used to assess rater reliability between the elderly cancer patients and their family caregivers. Correlations among the EORTC QLQ-C30 and the ECOG-PS were tested using the Kruskal-Wallis test and Spearmen’s correlation.

 Results

The results showed that four subscales of quality of life (physical functioning, emotional functioning, social functioning, and global health status) and three items under symptoms (fatigue, pain, and financial difficulties) in the EORTC QLQ-C30 were highly consistent between patients and their family caregivers. From the EORTC QLQ-C30 results, social functioning, role functioning, health status, fatigue, pain, and appetite loss (patients results) and physical functioning (family caregivers results) were highly consistent with the results of the ECOG-PS by the physicians.

 Conclusions

The findings suggest that when the older persons with cancer have difficulty expressing their own thoughts or feelings, the EORTC QLQ-C30 completed by their family caregivers and the results of the ECOG-PS completed by the physicians could be used as substitutes.

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Socio-demographic characteristics of older patients with cancer and their caregivers (n=222)

Characteristics Patienta Caregivera
Ageb 　 74.19±5.26 59.63±13.28
Less than 45 - 32 (14.7)
45-54 - 53 (24.3)
55-64 - 39 (17.9)
65-74 - 62 (28.4)
More than 75 - 32 (14.7)
65-69 51 (23.0) -
70-74 67 (30.2) -
75-79 67 (30.2) -
More than 80 37 (16.7) -
Gender Female 77 (34.7) 168 (75.7)
Male 145 (65.3) 54 (24.3)
Educationb Less than primary school 23 (10.4) 6 (2.7)
Primary school 71 (32.0) 47 (21.3)
Junior school 32 (14.4) 29 (13.1)
High school 48 (21.6) 84 (38.0)
College or more 48 (21.6) 55 (24.9)
Spouse Yes 160 (72.1) -
No 62 (27.9) -
Living situation Same household as children 175 (78.8) -
Not in same household 47 (21.2) -
Marital statusb Married - 199 (90.5)
Divorced/separated - 1 (0.5)
Widowed - 2 (0.9)
Single; never married - 18 (8.2)
Subjective economic status Much better than contemporaries - 3 (1.4)
Better than contemporaries - 19 (8.6)
Same as contemporaries - 79 (35.6)
Worse than contemporaries - 66 (29.7)
Much worse than contemporaries - 55 (24.8)
Employment Employed - 105 (47.5)
Not employed - 117 (52.5)
Relationship to patient Spouse/partner - 128 (57.7)
Parents - 5 (2.3)
Child - 85 (38.3)
Grandchild - 3 (1.4)
Brothers/sisters - 1 (0.5)
Care term 47.04±49.84
Less than 24 mo - 89 (40.1)
24-60 mo - 75 (33.8)
Over 60 mo 58 (26.2)

Values are presented as N (%) or mean±SD unless otherwise indicated.

Varies due to missing data (age 4 case, education 1 case, marital status 2 case).

Cancer characteristics of the patients (n=222)a

Characteristics
Cancer diagnosis Lung Stomach 17 (7.7) 78 (35.1)
Colorectal 90 (40.5)
Liver & ancreas 14 (6.3)
Prostate 12 (5.4)
Kidney 11 (5.0)
Performance status ECOG 0 135 (60.8)
ECOG 1 69 (31.1)
ECOG 2 13 (5.9)
ECOG 3 2 (0.9)
ECOG 4 3 (1.4)
Stage of the cancer at diagnosisb Stage I 75 (34.6)
Stage II 67 (30.9)
Stage III 53 (24.4)
Stage IV 22 (10.1)
Recurrence of cancer Recurrence 15 (6.8)
No recurrence 207 (93.2)

Abbreviation: ECOG, Eaastern Cooperative Oncology Group.

Values are presented as N(%).

Varies due to missing data (missing 5 case).

Relia ability and agreement between patient and caregiver EORTC QLQ-C30 ratings (n=222)

Number of items Number of response categories Reliability (α) Patient-caregiver correlation
r P ICCa P
Function 　 Physical 5 4 0.896 0.710 <0.001 0.835 <0.001
Role 2 4 0.849 0.549 <0.001 0.842 <0.001
Cognitive 2 4 0.704 0.466 <0.001 0.652 <0.001
Emotional 4 4 0.889 0.639 <0.001 0.884 <0.001
Social 2 4 0.904 0.729 <0.001 0.903 <0.001
Global QL 2 7 0.870 0.600 <0.001 0.867 <0.001
Symptoms Fatigue 3 4 0.884 0.715 <0.001 0.883 <0.001
Nausea/vomiting 2 4 0.830 0.646 <0.001 0.817 <0.001
Pain 2 4 0.884 0.684 <0.001 0.884 <0.001
Dyspnea 1 4 - 0.616 <0.001 0.780 <0.001
Sleep disturbance 1 4 - 0.507 <0.001 0.685 <0.001
Anorexia 1 4 - 0.532 <0.001 0.693 <0.001
Constipation 1 4 - 0.618 <0.001 0.768 <0.001
Diarrhea Financial impact 1 1 4 4 - - 0.603 0.662 <0.001 <0.001 0.765 0.800 <0.001 <0.001
Total QL score eb 30 - 0.936 0.742 <0.001 0.879 <0.001

Abbreviations: EORTC QLQ-C30, European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire, Core 30; ICC, intraclass correlation; QL, quality of life.

When comparing the patients and caregivers, the EORTC QLQ-C30 was used for correlation and intra-class correlation coefficient.

An aggregated score of the 15 functioning and symptom measures; for calculation of the total QL score, the nine symptom measures were reversed so that a higher total QL score represents a better quality of life.

Differences between family caregiver and elderly cancer patient EORTC QLQ-C30 ratings (n=222)a

Caregiver Patient Z-value P Absolute differenceb Directional differencec dd
Functioning scales
Physical 66.46±23.30 67.54±22.03 -0.113 0.910 11.88±12.46 -0.81±17.22 -0.05
Role 70.65±27.38 75.69±27.23 -2.826 0.005 17.43±19.45 -4.59±25.74 -0.18
Cognitive 77.33±21.83 75.84±20.97 -1.202 0.229 15.37±15.74 1.76±21.29 0.08
Emotional 75.94±20.83 79.43±20.24 -3.000 0.003 12.08±13.08 -3.29±17.52 -0.19
Social 76.50±27.36 79.82±25.77 -2.411 0.016 11.92±16.09 -3.36±19.76 -0.17
Global QL 57.06±23.32 53.90±20.38 -2.383 0.017 13.68±14.40 3.67±19.55 0.19
Symptoms scales
Fatigue 36.69±24.27 32.67±24.06 -3.094 0.002 13.61±12.53 3.52±18.18 0.19
Nausea/vomiting 10.36±17.16 7.11±15.34 -3.431 <0.001 7.26±12.27 3.29±13.88 0.24
Pain 21.55±26.48 20.72±26.44 -0.626 0.531 12.69±16.99 0.92±21.21 0.04
Dyspnea 22.77±27.99 20.17±25.18 -1.693 0.090 13.26±19.46 2.61±23.42 0.11
Sleep disturbance 26.66±29.68 26.29±29.26 -0.200 0.841 18.92±22.28 0.37±29.26 0.01
Anorexia 22.37±28.63 15.46±23.54 -3.868 <0.001 15.16±21.75 6.91±25.61 0.27
Constipation 21.12±30.19 18.18±26.15 -1.766 0.077 13.27±21.26 2.94±24.90 0.12
Diarrhea 15.24±22.29 11.13±21.27 -3.094 0.002 10.14±17.06 4.11±19.43 0.21
Financial impact 30.18±31.31 28.01±30.20 -1.366 0.172 14.45±20.86 2.17±25.30 0.09
Total QL score 74.51±16.99 76.83±15.17 -2.391 0.017 6.94±6.09 2.39±9.25 0.26

Abbreviations: EORTC QLQ-C30, European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire, Core 30; QL, quality of life.

Values are presented as mean±SD; When comparing the patient and caregiver differences was used for nonparametric statistics of Wilcoxon sign ranked.

Absolute difference between patient and caregiver score (indicator of agreement).

Difference between patient and caregiver score (indicator of bias).

Calculation by standardized difference d=mean difference/standard deviation of difference (d=0.2 small, d=0.5 moderate, d=0.8 lagre bias).

Comparisons of EORTC QLQ-C30 ratings by patients according to ECOG-PS rating scores (Kruskal-Wallis test and correlation) (n=222)a

ECOGb EORTC Kruskal-Wallis test Correlation
0 1 2 3 4 χ2 P γc P
Functioning scales
Physical 75.4±17.6 58.6±20.9 40.8±24.6 13.3±18.9 - 49.510 <0.001 -0.470 <0.001
Role 86.5±18.3 62.3±30.0 42.3±35.8 50.0±23.6 - 50.284 <0.001 -0.480 <0.001
Cognitive 80.0±17.3 73.3±22.9 47.4±26.2 66.7±23.6 - 21.623 <0.001 -0.259 <0.001
Emotional 83.6±17.6 74.6±21.2 61.5±28.6 79.2±29.5 - 16.377 0.001 -0.264 <0.001
Social 85.6±22.5 73.5±25.6 55.1±38.1 66.7±47.1 - 21.092 <0.001 -0.307 <0.001
Global QL 57.7±18.0 49.1±22.3 44.9±26.5 20.8±5.9 - 11.514 0.009 -0.200 <0.001
Symptoms scales
Fatigue 24.9±18.6 40.8±24.0 70.1±31.2 33.3±15.7 - 39.498 <0.001 0.407 <0.001
Nausea/vomiting 3.8±11.0 11.8±19.5 17.9±22.0 0.0±0.0 - 21.567 <0.001 0.292 <0.001
Pain 11.4±17.2 32.4±30.3 52.6±37.2 50.0±23.6 - 43.303 <0.001 0.444 <0.001
Dyspnea 11.6±17.4 31.2±29.1 46.2±32.0 50.0±23.6 19.4±0.0 40.775 <0.001 0.418 <0.001
Sleep disturbance 22.0±27.7 31.3±30.7 43.6±31.6 33.3±47.1 25.7±0.0 10.002 0.040 0.193 0.004
Anorexia 8.1±17.0 26.3±27.8 33.3±30.4 16.7±23.6 16.6±0.0 38.334 <0.001 0.411 <0.001
Constipation 16.3±26.0 21.5±27.3 17.9±22.0 33.3±47.1 17.4±0.0 3.728 0.444 0.122 0.070
Diarrhea 9.1±20.1 13.4±21.4 16.3±28.9 33.3±47.1 12.0±0.0 8.714 0.069 0.176 0.009
Financial impact 21.7±27.1 34.2±31.3 59.0±33.8 33.3±47.1 29.8±0.0 20.087 <0.001 0.262 <0.001

Abbreviations: EORTC QLQ-C30, European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire, Core 30; ECOG-PS, Eastern Cooperative Oncology Group-performance status; QL, quality of life.

Values are presented as mean±SD.

ECOG-performance status: 0 point-fully active, 1 point-restricted in physically strenuous activity, 2 point-ambulatory and capable of all self-care, 3 point-capable of only limited self-care, 4 point-completely disabled.

When comparing the patient’s EORTC QLQ-C30 and doctor’s ECOG was used for nonparametric statistics of Kruskal-Wallis test and Spearman’s correlation sign ranked.

Comparisons of EORTC QLQ-C30 ratings by caregivers according to ECOG-PS rating scores (Kruskal-Wallis test and correlation) (n=263)a

ECOG EORTC Kruskal-Wallis test Correlation b
0 1 2 3 4 F P γb P
Functioning scales
Physical 74.1±17.6 58.7±24.2 40.4±24.7 23.3±33.0 42.2±43.4 38.114 <0.001 -0.402 <0.001
Role 78.5±20.8 64.3±29.6 34.6±26.8 58.3±35.4 27.8±48.1 33.146 <0.001 -0.353 <0.001
Cognitive 81.1±19.1 74.2±22.8 64.1±26.2 50.0±0.0 55.6±50.9 13.637 0.009 -0.224 <0.001
Emotional 80.8±18.4 68.8±20.9 64.7±28.7 87.5±17.7 63.9±29.3 19.586 <0.001 -0.274 <0.001
Social 83.3±23.5 67.1±28.4 56.4±34.4 58.3±58.9 83.3±16.7 24.167 <0.001 -0.317 <0.001
Global QL 62.8±21.9 50.7±22.1 46.2±18.2 16.7±0.0 16.7±28.9 24.467 <0.001 -0.307 <0.001
Symptoms scales
Fatigue 29.1±20.3 43.6±22.0 68.4±30.7 44.4±0.0 74.1±35.7 38.005 <0.001 0.400 <0.001
Nausea/vomiting 6.8±13.2 16.4±20.1 16.7±27.2 0.0±0.0 11.1±9.6 18.557 0.001 0.242 <0.001
Pain 14.0±19.4 31.9±29.9 42.3±40.6 50.0±23.6 16.7±16.7 25.687 <0.001 0.327 <0.001
Dyspnea 13.3±18.8 31.9±29.4 53.0±38.0 83.3±23.6 66.7±57.7 39.250 <0.001 0.409 <0.001
Sleep disturbance 21.7±27.1 33.3±31.8 37.9±30.1 33.3±47.1 44.4±50.9 10.003 0.040 0.212 <0.001
Anorexia 14.1±21.0 33.3±32.8 38.5±35.6 33.3±0.0 66.7±57.7 26.900 <0.001 0.347 <0.001
Constipation 19.0±29.5 22.2±29.0 32.4±36.2 33.3±47.1 33.3±57.7 3.469 0.483 0.113 0.017
Diarrhea 13.7±20.9 15.9±20.3 20.5±32.0 33.3±47.1 33.3±57.7 1.645 0.801 0.077 0.050
Financial impact 24.9±29.3 35.7±31.0 51.3±37.6 50.0±70.7 33.3±33.3 11.510 0.021 0.219 <0.001

Abbreviations: EORTC QLQ-C30, European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire, Core 30; ECOG-PS, Eastern Cooperative Oncology Group-performance status; QL, quality of life.

Values are presented as mean±SD.

When comparing the caregiver’s EORTC QLQ-C30 and doctor’s ECOG was used for nonparametric statistics of Kruskal-Wallis test and Spearman’s correlation sign ranked.