Validation of EORTC quality-of-life questionnaire in Indian women with operable breast cancer

Abstract

Background: The European Organization for Research and Treatment of Cancer (EORTC) module QLQ-C30 and the breast cancer-specific module BR-23 have been validated world-wide to assess the quality of life ( QOL) in women with breast cancer. No such study has been published on Indian women using EORTC questionnaires. Methods: QOL was assessed in relation to surgery, adjuvant chemotheraphy, radiation therapy and hormone therapy in 299 Indian women with operable breast cancer (OBC) at the Breast Unit of Tata Memorial Hospital( TMH), Mumbai, from October 1998 to September 2001. The QLQ-C30 module was used to assess physical health, emotional, cognitive and social functioning, and the BR-23 module to assess breast cancer treatment-related symptoms. Assessment was done at 3 visits: visit 1 ( after surgery); visit 2 ( during adjuvant therapy) and visit 3 ( on completion of adjuvant therapy). Results: Of the 299 women at first visit, 274 (91.6%) completed the visit 2 questionnaire and 239 ( 80%) completed the visit 3 questionnaire. Only those women who filled the questionnaires at all 3 visits were included as 'valid visits' for analysis ( 193 of 299; 64.5%). The reliability and validity of the English and translated versions of the questionnaires were tested by Cronbach alpha (0.61-0.96) and item-scale correlation (0.63-0.93). Women with breast conversion treatment had a superior body image as compared to those with mastectomy (p<0.01). Physical, emotional and cognitive functions were not related to the type of surgery. Global QOL, physical, sexual and role functioning were found to deteriorate with chemo-therapy ( p≤0.01). Radiotherapy had only local adverse wffects (p<0.001), while hormone theraphy had no adverse impact on QOL. Conclusion: QLQ-C30 and BR-23 questionnaires can be used reliably to assess QOL in Indian patients. The translated versions were found to be valid for further use in clinical trials on Indian women with breast cancer.