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

Article information

Korean J Health Promot. 2015;15(3):150-159

Publication date (electronic) : 2015 December 19

doi : https://doi.org/10.15384/kjhp.2015.15.3.150

Kyoungwon Choi ¹, Hoonsik Bae^,², Yeon Ok Lim ³, Ilsung Nam ³, Hyunsook Yoon ¹, Yojin Kim ¹, Hyen Joo Lee ⁴

¹Department of Social Welfare, Graduate School of Hallym University, Chuncheon, Korea

²Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

³Hallym University Institute of Aging, Chuncheon, Korea

⁴Department 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

Received 2015 January 20; Accepted 2015 July 10.

Abstract

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.

Keywords: EORTC QLQ-C30; ECOG-PS; Elderly cancer patients; Family caregivers

Table 1.

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

Table 2.

Cancer characteristics of the patients (n=222)^a

Table 3.

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

Table 4.

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

Table 5.

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

Table 6.

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

References

1. Seo H, Park J, Kim S, Yang H, Nam E. Cancer facts & figures 2013 Goyang: National Cancer Center; 2013. [Accessed May 19, 2014]. http://www.cancer.go.kr/mbs/cancer/jsp/album/gallery.jsp?addCancerTitle=&spage=5&boardId=31817&boardSeq=399626&mcategoryId=&id=cancer_050207000000.

2. Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: a review. J Clin Epidemiol 1992;45(7):743–60.

3. Sneeuw KC, Aaronson NK, de Haan RJ, Limburg M. Assessing quality of life after stroke. The value and limitations of proxy ratings. Stroke 1997;28(8):1541–9.

4. Magaziner J, Simonsick EM, Kashner TM, Hebel JR. Patient-proxy response comparability on measures of patient health and functional status. J Clin Epidemiol 1988;41(11):1065–74.

5. Sneeuw KC, Aaronson NK, Sprangers MA, Detmar SB, Wever LD, Schornagel JH. Comparison of patient and proxy EORTC QLQ-C30 ratings in assessing the quality of life of cancer patients. J Clin Epidemiol 1998;51(7):617–31.

6. Epstein AM, Hall JA, Tognetti J, Son LH, Conant L Jr. Using proxies to evaluate quality of life. Can they provide valid information about patients' health status and satisfaction with medical care? Med Care 1989;27(3 Suppl):S91–8.

7. Clipp EC, George LK. Patients with cancer and their spouse caregivers. Perceptions of the illness experience. Cancer 1992;69(4):1074–9.

8. McPherson CJ, Wilson KG, Lobchuk MM, Brajtman S. Family caregivers' assessment of symptoms in patients with advanced cancer: concordance with patients and factors affecting accuracy. J Pain Symptom Manage 2008;35(1):70–82.

9. Tang ST. Concordance of quality-of-life assessments between terminally ill cancer patients and their primary family caregivers in Taiwan. Cancer Nurs 2006;29(1):49–57.

10. Tang ST. Predictors of the extent of agreement for quality of life assessments between terminally ill cancer patients and their primary family caregivers in Taiwan. Qual Life Res 2006;15(3):391–404. discussion 405-9.

11. Bridge M, Roughton DI, Lewis S, Barelds J, Brenton S, Cotter S, et al. Using caregivers-as-proxies to retrospectively assess and measure quality of dying of palliative care clients. Am J Hosp Palliat Care 2002;19(3):193–9.

12. Fayers PM, Machin D. Quality of life: Assessment, analysis and interpretation 1st ed.th ed. Chichester, UK: Wiley; 2000.

13. Wilson KA, Dowling AJ, Abdolell M, Tannock IF. Perception of quality of life by patients, partners and treating physicians. Qual Life Res 2000;9(9):1041–52.

14. Osoba D, Zee B, Pater J, Warr D, Kaizer L, Latreille J. Psychometric properties and responsiveness of the EORTC quality of Life Questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancer. Qual Life Res 1994;3(5):353–64.

15. Oliva EN, Nobile F, Alimena G, Ronco F, Specchia G, Impera S, et al. Quality of life in elderly patients with acute myeloid leukemia: patients may be more accurate than physicians. Haematologica 2011;96(5):696–702.

16. Janjua NZ, Khan MI, Clemens JD. Estimates of intraclass correlation coefficient and design effect for surveys and cluster randomized trials on injection use in Pakistan and developing countries. Trop Med Int Health 2006;11(12):1832–40.

17. Park J, Ko J, Kim S, Yoo H. Faculty observer and standardized patient accuracy in recording examinees' behaviors using checklists in the clinical performance examination. Korean J Med Educ 2009;21(3):287–97.

18. Milne DJ, Mulder LL, Beelen HC, Schofield P, Kempen GI, Aranda S. Patients' self-report and family caregivers' perception of quality of life in patients with advanced cancer: how do they compare? Eur J Cancer Care (Engl) 2006;15(2):125–32.

19. Yoon YH. Understanding and utilization of quality of life assessment 1st ed. Seoul: Koonja Corp.;2011. p. 109–16.

Article information Continued

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.

Table 1.

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

Characteristics		Patient^a	Caregiver^a
Age^b		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)
Education^b	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 status^b	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).

Table 2.

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 diagnosis^b	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)
Recurrence of cancer	No recurrence	207 (93.2)

Abbreviation: ECOG, Eaastern Cooperative Oncology Group.

Values are presented as N(%).

Varies due to missing data (missing 5 case).

Table 3.

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
		Number of items	Number of response categories	Reliability (α)	r	P	ICC^a	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	e^b	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.

Table 4.

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

	Caregiver	Patient	Z-value	P	Absolute difference^b	Directional difference^c	d^d
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).

Table 5.

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

ECOG^b EORTC	Kruskal-Wallis test							Correlation
ECOG^b EORTC	0	1	2	3	4	χ²	P	γ^c	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.

Table 6.

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
ECOG EORTC	0	1	2	3	4	F	P	γ^b	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

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.