Korean Journal of Health Promotion

Choi, Bae, Lim, Nam, Yoon, Kim, and Lee: 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

Original Article

Published online: December 19, 2015

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

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

Kyoungwon Choi¹, Hoonsik Bae², Yeon Ok Lim³, Ilsung Nam³, Hyunsook Yoon¹, Yojin Kim¹, Hyen Joo Lee⁴

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 January 20, 2015 Accepted July 10, 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.

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.

Key words: 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)

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)

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

^bVaries 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.

^aValues are presented as N(%).

^bVaries 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.

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

^bAn 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.

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

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

^cDifference between patient and caregiver score (indicator of bias).

^dCalculation 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.

^aValues are presented as mean±SD.

^bECOG-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.

^cWhen 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

^aValues are presented as mean±SD.

^bWhen 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.

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