Psychometric properties of the Spanish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).

PURPOSE: The aim of this study was to analyze the internal structure of the EORTC QLQ-C30, to examine the validity and normative data for cancer patients. METHOD: Exploratory and Confirmatory factor analyses were conducted to explore the scale's dimensionality and test for strong measurement invariance across sex and tumor site. All the analyses were based on a multicenter cohort of 931 patients who completed the Brief Symptom Inventory (BSI-18) and the EORTC QLQ-C30. RESULTS: Our findings indicate that the EORTC QLQ-C30 has acceptable psychometric properties and an internal structure that is well accounted for a bifactor model: a general factor that evaluates quality of life and a group factor that would analyze physical health that would be defined by physical function, role function, and fatigue. The result of the multi-group CFA revealed a strong invariance according to sex, tumor, and over time. Reliability of the EORTC exceeding 0.86 and the simple sum of the items of the scale was a good indicator of oncology patients' quality of life. Both factors correlate closely with depression, anxiety, and psychological distress and are sensitive to change, especially the quality of life, with a significant decrease in the post-test. CONCLUSION: The Spanish version of the EORTC QLQ-C30 proved to be a valid, reliable instrument to appraise quality of life in cancer patients. The normative data collected from this study may be useful for the early detection of initial symptoms of deterioration of quality of life in oncology patients.

Impact of Obesity on Quality of Life, Psychological Distress, and Coping on Patients with Colon Cancer.

BACKGROUND: Despite the causal relationship between obesity and colon cancer being firmly established, the effect of obesity on the course of cancer calls for further elucidation. The objective of this study was to assess differences in clinical-pathological and psychosocial variables between obese and nonobese individuals with colon cancer. MATERIALS AND METHODS: This was a prospective, multicentric, observational study conducted from 2015-2018. The sample comprised patients with stage II-III, resected colon cancer about to initiate adjuvant chemotherapy with fluoropyrimidine in monotherapy or associated with oxaliplatin and grouped into nonobese (body mass index <30 kg/m2 ) or obese (≥30 kg/m2 ). Subjects completed questionnaires appraising quality of life (European Organization for Research and Treatment of Cancer Quality of Life Core questionnaire), coping (Mini-Mental Adjustment to Cancer), psychological distress (Brief Symptom Inventory 18), perceived social support (Multidimensional Scale of Perceived Social Support), personality (Big Five Inventory 10), and pain (Brief Pain Inventory). Toxicity, chemotherapy compliance, 12-month recurrence, and mortality rate data were recorded. RESULTS: Seventy-nine of the 402 individuals recruited (19.7%) were obese. Obese subjects exhibited more comorbidities (≥2 comorbidities, 46.8% vs. 30.3%, p = .001) and expressed feeling slightly more postoperative pain (small size-effect). There was more depression, greater helplessness, less perceived social support from friends, and greater extraversion among the obese versus nonobese subjects (all p < .04). The nonobese group treated with fluoropyrimidine and oxaliplatin suffered more grade 3-4 hematological toxicity (p = .035), whereas the obese had higher rates of treatment withdrawal (17.7% vs. 7.7%, p = .033) and more recurrences (10.1% vs. 3.7%, p = .025). No differences in sociodemographic, quality of life, or 12-month survival variables were detected. CONCLUSION: Obesity appears to affect how people confront cancer, as well as their tolerance to oncological treatment and relapse. IMPLICATIONS FOR PRACTICE: Obesity is a causal factor and affects prognosis in colorectal cancer. Obese patients displayed more comorbidities, more pain after cancer surgery, worse coping, and more depression and perceived less social support than nonobese patients. Severe hematological toxicity was more frequent among nonobese patients, whereas rates of withdrawal from adjuvant chemotherapy were higher in the obese cohort, and during follow-up, obese patients presented greater 12-month recurrence rates. With the growing and maintained increase of obesity and the cancers associated with it, including colorectal cancer, the approach to these more fragile cases that have a worse prognosis must be adapted to improve outcomes.

Psychological factors and prognostic communication preferences in advanced cancer: multicentre study.

OBJECTIVES: Communication regarding prognosis to patients with advanced cancer is fundamental for informed medical decision making. Our objective was to analyse (1) the proportion of subjects with advanced cancer who prefer to know their prognosis, (2) the characteristics associated with patients' preference for prognostic information, (3) the psychological factors that impact the preference to know prognosis and 4) the concordance between preference for prognostic information perceived among physicians and patients. METHODS: A prospective, cross-sectional design was adopted. Data were collected from 748 participants with advanced cancer at 15 tertiary hospitals in Spain. Participants completed the following questionnaires: Mental Adjustment to Cancer; Trust in the Physician; Uncertainty in Illness Scale Patient's Prognostic Preferences. RESULTS: Fifty-two per cent of advanced cancer sufferers preferred to know the prognosis of their disease. Compared with participants who preferred not to know, those who did reported more uncertainty, greater satisfaction with their physician and higher scores on positive attitude (all p=0.001). Thirty-seven per cent of the physicians believed that patients want to know their prognosis, indicating that they underestimate the number of such patients. No significant differences were found regarding preference to know prognosis as a function of sociodemographic and clinical variables. CONCLUSIONS: A substantial proportion of individuals with advanced cancer prefer to know the prognosis of their disease. It appears that knowing their prognosis was mainly motivated by a need to maintain a positive attitude, lessen uncertainty and by satisfaction with the physician. It is important to explore patients' preferences for information to offer more personalised communication.

Psychometric Properties and Measurement Invariance of the Herth Hope Index in Spanish Cancer Patients.

BACKGROUND: The aim of this study was to evaluate the psychometric properties, differential item functioning, factorial invariance, and convergent validity of the Spanish version of the Herth Hope Index (HHI) in patients with cancer. METHOD: Exploratory and confirmatory factor analyses were conducted to explore the scale, dimensionality, functioning of items, test for strong measurement invariance across sex, age, tumor site, and expected survival, and an extended structural equation model to assess external validity in a cross-sectional, multicenter, prospective study of 863 cancer patients from 15 Spanish hospitals. RESULTS: The results do not support the original 3-factor scale but instead suggest a one-factor structure, which explained 62% of the common variance. Scores from the unidimensional structure exhibited satisfactory reliability (ω = .88). A strong invariance solution demonstrated excellent fit across sex, age, tumor site, and survival. HHI exhibited substantial associations with resilience coping strategies and spiritual well-being. CONCLUSIONS: The findings of our study contribute to the diversity of earlier empirical findings regarding the construct of hope. Despite this, our results indicate that the Spanish version of the HHI is a short, easy-to-administer, valid, reliable tool for evaluating cancer patients' levels of hope.

Multidimensional Scale of Perceived Social Support (MSPSS) in cancer patients: psychometric properties and measurement invariance.

BACKGROUND: The aim of this study was to evaluate the psychometric properties, convergent validity, and factorial invariance of the Multidimensional Scale of Perceived Social Support (MSPSS) in cancer patients. METHOD: Confirmatory factor analysis (CFA) was conducted to explore the scale's dimensionality and test for strong measurement invariance across sex and age in a cross-sectional, multicenter, prospective study. Patients completed the MSPSS and Satisfaction with Life Scale (SWLS). RESULTS: A total of 925 consecutive patients were recruited in 13 hospitals between July 2015 and December 2018. The CFA indicated that the original three-factor model was replicated in patients with cancer. The results of the multi-group CFA revealed a strong invariance according to sex and age. The Spanish version of the MSPSS had high estimated reliability with values exceeding .90. The simple sum of the items of each scale was a good indicator of oncology patients' perceived social support. The three MSPSS subscales correlated significantly with the SWLS. Women scored higher on social support by friends than men. CONCLUSION: The Spanish version of the MSPSS proved to be a valid, reliable instrument to assess perceived social support in cancer patients.

Psychometric properties of Spanish version of the Mini-Mental Adjustment to Cancer Scale.

BACKGROUND/OBJECTIVE: The aim of the study was to examine the factor structure and psychometric properties of the Spanish version of the Mini-Mental Adjustment to Cancer Scale (Mini-MAC) in a large sample of patients with non-metastatic, resected cancer. METHODS: Prospective, observational, multicenter study for which 914 patients were recruited from 15 Spanish hospitals. Exploratory and confirmatory factor analyses, validity and reliability analyses were conducted. RESULTS: Factor-analytic results indicated a 4-factor structure of the Spanish version of the Mini-MAC. Three subscales have psychometric properties similar to those of Helplessness, Anxious preoccupation, and Cognitive avoidance of the original the Mini-MAC. The Fighting spirit and the Fatalism subscales were combined on the Positive attitude scale. The four factor-derived scale scores exhibited acceptable accuracy for individual measurement purposes, as well as stability over time in test-retest assessments at 6 months. Validity assessments found meaningful relations between the derived scale scores, and Brief Symptom Inventory depression and anxiety scores and Functional Assessment of Chronic Illness Therapy spiritual well-being scores. CONCLUSIONS: The Spanish version of the Mini-MAC provides reliable and valid measures for patients with non-metastatic, resected cancer, and results corroborate the instrument's cross-cultural validity.

ANTECEDENTES/OBJETIVO: El objetivo de este estudio fue analizar las propiedades psicométricas de la versión Española del Mini-Mental Adjustment to Cancer Scale (Mini-MAC) en pacientes con cáncer resecado, no metastásico. MÉTODO: Estudio multicéntrico, prospectivo y observacional con 914 pacientes reclutados en 15 hospitales de España. Se llevaron a cabo análisis factorial exploratorio y confirmatorio, así como análisis de la validez y fiabilidad de las puntuaciones de la escala. RESULTADOS: Los resultados de los análisis factoriales sugieren que la estructura más apropiada para la versión española del Mini-MAC es la de cuatro factores. Tres subescalas derivadas de esta estructura tienen propiedades psicométricas similares a la escala original: Desesperanza, Preocupación ansiosa y Evitación cognitiva. Las subescalas Espíritu de lucha y Fatalismo se combinaron en la escala Actitud positiva. Las puntuaciones en las cuatro escalas mostraron una fiabilidad aceptable para su utilización en la evaluación individual, así como estabilidad a lo largo del tiempo en evaluaciones test-retest a los seis meses. Se obtuvieron evidencias de validez en forma de relaciones significativas con las escalas de ansiedad y depresión del BSI, y de bienestar espiritual del FACIT. CONCLUSIONES: La versión Española del Mini-MAC proporciona puntuaciones fiables y válidas para evaluar las estrategias de afrontamiento en pacientes con cáncer y los resultados añaden evidencia a favor de la validez transcultural del instrumento.

Psychometric Properties of the PDRQ-9 in Cancer Patients: Patient-Doctor Relationship Questionnaire.

BACKGROUND: The patient-doctor relationship is an important concept in health care. The aim of this study was to evaluate the psychometric properties, convergent validity, and factorial invariance of the Patient-Doctor Relationship Questionnaire (PDRQ-9). METHOD: Confirmatory factor analysis was conducted to explore the scale's dimensionality and test for strong measurement invariance across sex, age, and tumor site in a prospective, multicenter cohort of 560 patients who completed the PDRQ-9, Health-related Quality of Life Questionnaire (EORTC-QLQ-C30), and Brief Symptom Inventory (BSI) scales. RESULTS: The data supported a unidimensional structure. Thresholds and factor loadings could be constrained to be invariant across sex, age, and tumor site, indicating strong measurement invariance. Scores derived from the unidimensional structure exhibited satisfactory degrees of reliability and determinacy. Evidence of convergent validity was supported by modest positive correlations with functional (p<.001) and global quality-of-life (p<.001) and negative correlations with psychological distress (p<.001). Low satisfaction with the oncologist was associated with anxiety (p=.006), and depression (p=.004). CONCLUSIONS: The PDRQ-9 is a suitable, valid instrument for assessing the quality of patient-doctor relationships in cancer patients.

Effects of pessimism, depression, fatigue, and pain on functional health-related quality of life in patients with resected non-advanced breast cancer.

INTRODUCTION: The aim was to analyze the effects of pessimism, depression, fatigue, and pain on functional health-related quality of life (HRQoL) in patients with resected, non-advanced breast cancer. METHODS: A prospective, multicenter study was conducted in 440 breast cancer patients. They completed the Brief Symptom Inventory (BSI), the European Organization for Research and Treatment of Cancer QoL-Questionnaire-Core-30 (EORTC-QLQ-C30), and the Revised Life Orientation Test (LOT-R). RESULTS: Prevalence rates of pessimism and depression were 23.3% and 40.0%, respectively. Fatigue and pain were the most common symptoms, 8.8% and 4.2%, respectively. Patients without a partner were more pessimistic that partnered ones; those with a lower level of education and subjects without a partner exhibited more depression. Depression was a major factor that proved to have the greatest explanatory power for HRQoL (physical, role, emotional, cognitive, and social functioning) and global health status (R2 range: 0.13 to 0.39). Of the five domains, fatigue had a significant effect on four and pain, on two. CONCLUSION: This study reveals the impact of depression and pessimism on physical, psychological, social, and quality-of-life aspects and the importance of evaluating them in patients who are going to initiate adjuvant chemotherapy for breast cancer.

Racial/ethnic differences in the prevalence of internalizing symptoms: do Latin-American immigrant show more symptomatology than Spanish native-born adolescents?

This study mainly compared the prevalence of internalizing symptoms of 834 Spanish and 159 Latin-American immigrant adolescents. Participants completed self-report measures about depression, anxiety and somatic symptoms and a socio-demographic questionnaire. The results indicated that being Latin-American was associated with higher levels of depressive symptoms and being female was related to higher depressive and anxiety symptoms. Gender differences were more prevalent in Spaniards than in Latinos, with girls showing more symptoms than boys. High socio-economic status was negatively related to depressive symptoms and anxiety. The results may alert clinicians of the importance of assessing depressive symptoms in Latino adolescents in order to treat this group of youths effectively.