Translation and validation of EORTC QLQ-H&N 35 into Moroccan Arabic for ENT head and neck cancer patients in Morocco

Abstract

Disease-specific quality of life (QOL) measures have enhanced the capacity of outcome measures to evaluate subtle changes and differences between groups. As many of the QOL measures have been developed in English, they require translation to ensure their usefulness in a multi-cultural and/or international society. Published guidelines provide formal methods to achieve cross-culturally comparable versions of a QOL tool. The aim of this study was to adapt the head and neck specific module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-H&N 35 questionnaire) into Moroccan Arabic and to determine its psychometric properties. After translation, back translation and pretesting of the pre-final version, the translated version was submitted to a committee of professionals composed by otolaryngologists and epidemiologists. The psychometric properties were tested in patients with ENT cancer. Internal consistency was tested using Cronbach's alpha and the test-retest reliability using interclass correlation coefficients. Construct validity was assessed by examining item convergent and divergent validity. It was also tested using Spearman's correlation between QLQ-H&N 35 scales and EQ-5D. The study was conducted in 120 patients. The Moroccan version was internally reliable, Cronbach's α ranged from 0.71 for "trouble with social contact" to 0.94 for "senses impairment", indicating good internal consistency. Test-retest reliability was assessed using the intra-class correlation coefficient, which ranged from 0.64 for "speech trouble" to 0.89 for "physical activities". The instrument demonstrated a good construct and concomitant validity. We have developed a semantically equivalent translation with cultural adaptation of EORTC QLQ-H&N 35 questionnaire. The assessment of its measurement properties showed that it is quite reliable and a valid measure of the effect of cancer on the quality of life in Moroccan patients.

A systematic literature review of health state utility values in head and neck cancer

“…In studies administering MAUIs, EQ-5D was the most common ( n = 11); five of these studies [ 36 , 37 , 47 – 49 ] did not report which scoring algorithm was used, two studies [ 50 , 51 ] explicitly adopted the UK algorithm, another two [ 52 , 53 ] adopted the US one, one study [ 54 ] used the Dutch tariff and another one [ 55 ] the Belgian one. Moreover, nine of the studies using EQ-5D [ 36 , 47 , 48 , 50 – 55 ] explicitly referred to the 3-level version (EQ-5D-3 L) and one [ 37 ] to the newer 5-level one (EQ-5D-5 L); one study [ 49 ] did not specify the instrument’s version adopted. Additional generic, preference-based HRQoL tools retrieved by our search were 15D ( n = 2), HUI3 ( n = 2) and SF-6D ( n = 1); no studies used the QWB scale or the AQoL-8D utility instrument.…”

“…Conversely, responders were generally younger and with a higher proportion of females in studies surveying individuals from the general population or clinical experts. The range of cancer subsites addressed by each study was quite broad: ten studies [ 36 , 37 , 40 , 41 , 47 , 48 , 51 , 52 , 55 , 56 ] generally investigated utility in HNC without specifying any cancer site, six [ 39 , 42 , 45 , 46 , 49 , 58 ] were related to laryngeal cancer, two [ 38 , 44 ] addressed cancer in the oropharynx, one [ 54 ] recruited patients affected by cancer in the oral cavity and the remaining six [ 20 , 43 , 50 , 53 , 57 , 59 ] focused on selected multiple sites (e.g. oropharynx, hypopharynx, and larynx).…”

“…The most common way ( n = 12 [ 41 , 48 – 58 ]) of collecting utility data was by self-completion of a written survey (administered on site or by post/e-mail), followed by face-to-face interviews ( n = 6 [ 37 , 39 , 42 , 44 – 46 ]); four studies adopted different administration options including group session ( n = 1 [ 38 ]), telephone or mail interview ( n = 1 [ 59 ]), interview using a script/prop ( n = 1 [ 20 ]), and computer-guided data collection ( n = 1 [ 36 ]). The administration method was not specified in three cases [ 40 , 43 , 47 ].…”

“…Second, there might be potential sources of bias in reporting HRQoL results in clinical studies investigating one or more interventions, although the number of comparative trials retrieved by our search was very limited. Third, in some studies [ 36 , 48 , 59 , 60 ], and especially those analyzing HRQoL in multiple cancers including head and neck [ 36 , 59 ], patient’s characteristics (e.g. cancer stage/site, treatment phase) are poorly reported, thus making it difficult to match the study’s HSUVs with the health states described in a cost-effectiveness model.…”

Patient‐reported outcomes for dental health, shoulder‐neck dysfunction, and overall quality of life after treatment with radiation for head and neck cancer

“…The EORTC questionnaires are frequently used in QOL studies in patients with cancer; the EORTC QLQ-C30 and QLQ-H&N35 have been validated in patients with head and neck cancer. [7][8][9][10][11] The EORTC QLQ-C30 is a standard questionnaire with 30 items regarding physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning. Scores range from 0 to 100 and are calculated according to the EORTC QLQ-C30 scoring manual.…”