European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: factorial models to Brazilian cancer patients

Campos, Juliana Alvares Duarte Bonini; Spexoto, Maria Cláudia Bernardes; Silva, Wanderson Roberto da; Serrano, Sergio Vicente; Marôco, João

doi:10.1590/S1679-45082018AO4132

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Original Article • Einstein (São Paulo) 16 (1) • 2018 • https://doi.org/10.1590/S1679-45082018AO4132 copy

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: factorial models to Brazilian cancer patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate the psychometric properties of the seven theoretical models proposed in the literature for European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), when applied to a sample of Brazilian cancer patients.

Methods

Content and construct validity (factorial, convergent, discriminant) were estimated. Confirmatory factor analysis was performed. Convergent validity was analyzed using the average variance extracted. Discriminant validity was analyzed using correlational analysis. Internal consistency and composite reliability were used to assess the reliability of instrument.

Results

A total of 1,020 cancer patients participated. The mean age was 53.3±13.0 years, and 62% were female. All models showed adequate factorial validity for the study sample. Convergent and discriminant validities and the reliability were compromised in all of the models for all of the single items referring to symptoms, as well as for the “physical function” and “cognitive function” factors.

Conclusion

All theoretical models assessed in this study presented adequate factorial validity when applied to Brazilian cancer patients. The choice of the best model for use in research and/or clinical protocols should be centered on the purpose and underlying theory of each model.

Keywords
Quality of life; Neoplasms; Validation studies; Psychometrics

Model	Second-order factor	First-order factor	Items	Correlated factors
a	-	Quality of life	→29, 30	All
	-	Physical function	→1, 2, 3, 4, 5
	-	Role function	→6, 7
	-	Emotional function	→21, 22, 23, 24
	-	Cognitive function	→20, 25
	-	Social function	→26, 27
	-	Fatigue	→10, 12, 18
	-	Nausea and vomiting	→14, 15
	-	Pain	→9, 19
	-	Spurious	→8, 11, 13, 16, 17
b	-	Quality of life	→29, 30	Quality of life, mental health and physical health
	Physical health	→Physical function	→1, 2, 3, 4, 5
		→Nausea and vomiting	→14, 15
		-	→11, 13, 16, 17
	Mental health	→Emotional function	→21, 22, 23, 24
		→Cognitive function	→20, 25
	Both factors (mental health and physical health)	→Social function	→26, 27
		→Fatigue	→10, 12, 18
		→Role function	→6, 7
		→Pain	→9, 19
		-	→8
b adapted	-	Quality of life	→29, 30	Quality of life, mental health and physical health
	Physical health	→Physical function	→1, 2, 3, 4, 5
		→Nausea and vomiting	→14, 15
		→Role function	→6, 7
		→Fatigue	→10, 12, 18
		→Pain	→9, 19
		-	→8, 11, 13, 16, 17
	Mental health	→Emotional function	→21, 22, 23, 24
		→Cognitive function	→20, 25
		→Social function	→26, 27
		→Pain	→9, 19
		-	→8
c	-	Quality of life	→29, 30	Quality of life, mental function and physical burden
	Physical burden	→Physical function	→1, 2, 3, 4, 5
		→Fatigue	→10, 12, 18
		→Nausea and vomiting	→14, 15
		→Pain	→9, 19
		-	→8, 11, 13, 16, 17
	Mental function	→Emotional function	→21, 22, 23, 24
		→Cognitive function	→20, 25
	Both factors (mental function and physical burden)	→Role function	→6, 7
		→Social function	→26, 27
c adapted	-	Quality of life	→29, 30	Quality of life, mental function and physical burden
	Physical burden	→Physical function	→1, 2, 3, 4, 5
		→Fatigue	→10, 12, 18
		→Nausea and vomiting	→14, 15
		→Pain	→9,19
		-	→8, 11, 13, 16, 17
		→Role function	→6, 7
	Mental function	→Emotional function	→21, 22, 23, 24
		→Cognitive function	→20, 25
		→Social function	→26, 27
d	-	Quality of life	→29, 30	Quality of life, function and burden
	Function	→Physical function	→1, 2, 3, 4, 5
		→Role function	→6, 7
		→Emotional function	→21, 22, 23, 24
		→Cognitive function	→20, 25
		→Social function	→26, 27
	Burden	→Fatigue	→10, 12, 18
		→Nausea and Vomiting	→14, 15
		→Pain	→9, 19
		-	→8, 11, 13, 16, 17
e	-	Quality of life	→29, 30	Quality of life and health-related quality of life
	Health-related quality of life	→Physical function	→1, 2, 3, 4, 5
		→Role function	→6, 7
		→Emotional function	→21, 22, 23, 24
		→Cognitive function	→20, 25
		→Social function	→26, 27
		→Fatigue	→10, 12, 18
		→Nausea and Vomiting	→14, 15
		→Pain	→9, 19
		-	→8, 11, 13, 16, 17
f^* * formative first-order factors with freely estimated weights; and g^† † formative first-order factors with fixed weights. The arrows refer to the direction of the trajectories that must be used to build the model.		Quality of life	→29, 30	None
	Function	→Physical function	→1, 2, 3, 4, 5
		→Role function	→6, 7
		→Emotional function	→21, 22, 23, 24
		→Cognitive function	→20, 25
		→Social function	→26, 27
	Burden	←Fatigue	→10, 12, 18
		←Nausea and vomiting	→14, 15
		←Pain	→9, 19
		-	←8, 11, 13, 16, 17
		→Quality of life and function	-

Model	CFA							e	AVE	CR	α
Model	λ	β (p<0.001)	χ²/df	CFI	TLI	RMSEA (90%CI)	r²	e	AVE	CR	α
a complete^* * original;	0.22-1.00	-	3.07	0.97	0.96	0.045 (0.042-0.049)	0.05-0.83	-	0.21-0.88	0.54-0.94	0.40-0.84
a refined^† † fitted;	0.45-1.00	-	3.59	0.97	0.96	0.051 (0.047-0.054)	0.05-0.83	16, 17	0.30-0.88	0.56-0.94	0.39-0.84
a refined^† † fitted; (without spurious factor)	0.53-1.00	-	3.99	0.97	0.96	0.055 (0.051-0.058)	0.05-0.83	-	0.55-0.88	0.66-0.94	0.40-0.84
b adapted	0.23-1.00	0.39-0.96	5.76	0.92	0.91	0.069 (0.066-0.072)	0.29-0.63	-	0.23-0.88	0.57-0.94	0.40-0.84
b adapted^‡ ‡ adapted model by authors. refined^† † fitted;	0.48-1.00	0.39-0.97	6.60	0.92	0.91	0.075 (0.072-0.078)	0.29-0.63	16, 17	0.32-0.88	0.58-0.94	0.40-0.84
c adapted^‡ ‡ adapted model by authors.	0.22-1.00	0.59-0.95	3.54	0.96	0.95	0.050 (0.047-0.053)	0.32-0.65	-	0.25-0.88	0.59-0.94	0.40-0.84
c adapted^‡ ‡ adapted model by authors. refined^† † fitted;	0.47-1.00	0.59-0.95	4.01	0.95	0.95	0.055 (0.052-0.058)	0.32-0.64	16, 17	0.36-0.88	0.62-0.93	0.30-0.84
d	0.23-0.99	0.57-0.98	3.99	0.95	0.95	0.055 (0.052-0.058)	0.30-0.83	-	0.27-0.87	0.62-0.93	0.40-0.84
d refined^† † fitted;	0.48-0.99	0.58-0.99	4.54	0.95	0.94	0.059 (0.056-0.062)	0.29-0.83	16, 17	0.39-0.87	0.65-0.93	0.30-0.84
e	0.22-0.99	0.57-0.94	3.99	0.95	0.94	0.055 (0.052-0.057)	0.38	-	0.24-0.87	0.58-0.93	0.40-0.84
e refined^‡ ‡ adapted model by authors.	0.47-1.00	0.57-0.94	4.53	0.95	0.94	0.059 (0.056-0.062)	0.38	16, 17	0.35-0.88	0.61-0.94	0.30-0.84
f	0.54-1.00	0.20-1.00	3.73	0.96	0.95	0.052 (0.049-0.055)	-	-	0.18-0.88	0.49-0.88	0.40-0.84
g	0.54-1.00	0.20-1.00	3.74	0.96	0.95	0.052 (0.049-0.055)	-	-	0.19-0.88	0.51-0.93	0.40-0.84

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[1] Corresponding author: Juliana Alvares Duarte Bonini Campos Rodovia Araraquara Jaú, km 01, s/n Campos Ville – Zip code: 14800-903 Araraquara, SP Brazil Phone: (55 16) 3301-6358 E-mail: jucampos@fcfar.unesp.br