Psychometric Analysis of a Persian Version of the European Organization for Research and Treatment of Cancer OG25 Quality of Life Questionnaire in Oesophagogastric Cancer Patients

  • Hesari, Ali Esmaeili (Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences) ;
  • Lari, Mohsen Asadi (Department of Radiotherapy, Cancer Research Centre, Mashad University of Medical Sciences) ;
  • Shandiz, Fatemeh Homai (Department of Epidemiology, and Oncopathology Research Centre, Iran University of Medical Sciences)
  • Published : 2014.03.30


Background: Health-related quality of life (HRQL) is a fundamental outcome in oncology patients and quality of life (QOL) assessment requires clinically relevant questionnaires. The purpose of this study was translation and definition of measurement properties and the clinical validity of Quality of Life Questionnaire (QLQ)-OG25 module in Persian patients with oesophagus, oesophagogastric junction (OGJ) or gastric cancers. Materials and Methods: The translation procedure followed European Organization for Research and Treatment of Cancer (EORTC) guidelines. Both EORTC QLQ-OG25 and a core questionnaire (EORTC QLQ-C30) were administered to patients with oesophagus (150), OG junction (93) and gastric (32) cancer undergoing multi-modal treatments. Convergent and discriminant validity, Cronbach's alpha coefficient and known-groups comparisons were used to examine reliability and validity. Results: In all, 275 patients (mean age 62 years) completed both questionnaires. Compliance rate was high and the questionnaire module was well accepted. We found good reliability for multi-item subscales of QLQ-OG25 (Cronbach's alpha coefficients 0.76-0.89). About 73% had TNM staging and scales distinguished between clinically distinct groups of patients. However, patients in palliative group experienced compromised functional status and worse treatment-associated symptoms than those in the potentially curative group. Test-retest scores were consistent. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Conclusions: Overall, the Persian version of QLQ-OG25 demonstrated psychometric and clinical validity that supports its application as a supplement to the original tool (EORTC QLQ-C30) when assessing HRQL in patients with upper-gastrointestinal (GI) cancer both in curative and palliative phases.


Health related quality of life;EORTC QLQ-OG25;psychometric properties;Iran


  1. Schuhmacher C, Reim D, Novotny A (2013). Neoadjuvant treatment for gastric cancer. J Gastric Cancer, 13, 73-8.
  2. Xu Y, Yu X, Chen Q, et al (2012). Neoadjuvant versus adjuvant treatment: which one is better for resectable esophageal squamous cell carcinoma? World J Surg Oncol, 10, 173.
  3. Yun YH, Park YS, Lee ES, et al (2004). Validation of the Korean version of the EORTC QLQ-C30. Quality of Life Res, 13, 863-8.
  4. Zhang HZ, Jin GF, Shen HB (2012). Epidemiologic differences in esophageal cancer between Asian and Western populations. Chin J Cancer, 31, 281-6.
  5. Pourshams A, Khademi H, Malekshah AF, et al (2010). Cohort Profile: The Golestan Cohort Study-a prospective study of oesophageal cancer in northern Iran. Int J Epidemiol, 39, 52-9.
  6. Sadjadi A, MalekzadehR, Derakhshan MH, et al (2003). Cancer occurrence in Ardabil: results of a population-based cancer registry from Iran. Int J Cancer, 107, 113-8.
  7. Sepanlou SG, Etemadi A, Kamangar F, et al (2013). The gastroesophageal malignancies in Northern Iran research project: impact on the health research and health care systems in Iran. Arch Iran Med, 16, 46-53.
  8. Taghavi N, Nasrollahzadeh D, Merat S, et al (2007). Epidemiology of upper gastrointestinal cancers in Iran: a sub site analysis of 761 cases. World J Gastroenterol, 13, 5367.
  9. Tomaszewski KA, Puskulluoglu M, Biesidad K, et al (2013). Validation of the polish version of the eortc QLQ-C30 and the QLQ-OG25 for the assessment of health-related quality of life in patients with esophagi-gastric cancer. J Psychosoc Oncol, 31, 191-203.
  10. Montazeri A, Harirchi I, Vahdani M, et al (1999). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): translation and validation study of the Iranian version. Support Care Cancer, 7, 400-6.
  11. Mohebbi M, Mahmoodi M, Wolfe R, et al (2008). Geographical spread of gastrointestinal tract cancer incidence in the Caspian Sea region of Iran: spatial analysis of cancer registry data. BMC Cancer, 8, 137.
  12. Moradpour F, Fatemi Z (2013). Estimation of the projections of the incidence rates, mortality and prevalence due to common cancer site in Isfahan, Iran. Asian Pac J Cancer Prev, 14, 3581-5.
  13. Mohebbi M, Wolfe R, Jolley D, et al (2011). The spatial distribution of esophageal and gastric cancer in Caspian region of Iran: An ecological analysis of diet and socioeconomic influences. Int J Health Geogr, 10, 13.
  14. Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer incidence and mortality in Iran. Ann Oncol, 20, 556-63.
  15. Nagini S (2012). Carcinoma of the stomach: A review of epidemiology, pathogenesis, molecular genetics and chemoprevention. World J Gastrointest Oncol, 4, 156-69.
  16. Najafi F, Mozaffari HR, Karami M, et al (2011). Trends in Incidence of Gastrointestinal Tract Cancers in Western Iran, 1993-2007. Iran Red Crescent Med J, 13, 805-10.
  17. Onate-Ocana LF, Velazquez-Monroy N, Vazquez L, et al (2012). Clinical validation of the EORTC QLQ-OG25 questionnaire for the evaluation of health-related quality of life in Mexican patients with esophagogastric cancers. Psychooncology, 21, 745-53.
  18. Otterstatter MC, Brierley JD, De P, et al (2012). Esophageal cancer in Canada: Trends according to morphology and anatomical location. Can J Gastroenterol, 26, 723-7.
  19. Lin Y, Ueda J, Kikuchi S, et al (2011). Comparative epidemiology of gastric cancer between Japan and China. World J Gastroenterol, 17, 4421-8.
  20. Lee CW, Chi KN (2000). The standard of reporting of healthrelated quality of life in clinical cancer trials. J Clin Epidemiol, 53, 451-8.
  21. Lin J-Y, Wang M-S, Dong LP, et al (2012). Influence of personal character on quality of life of patients with esophageal cancer in north henan province and influencing factors. Asian Pac J Cancer Prev, 13, 5415-20.
  22. Lin Y, Totsuka Y, He Y, et al (2013). Epidemiology of esophageal cancer in Japan and China. J Epidemiol, 23, 233-42.
  23. Matsuschek C, Bolke E, Peiper M, et al (2011). The role of neoadjuvant and adjuvant treatment for adenocarcinoma of the upper gastrointestinal tract. Eur J Med Res, 16, 265-74.
  24. Mehrabani D, Hosseini SV, Rezaianzadeh A, et al (2013). Prevalence of stomach cancer in Shiraz, Southern Iran. J Res Med Sci, 18, 335-7.
  25. Mohagheghi MA, Mosavi-Jarrahi A, Malekzadeh R, Parkin M (2009). Cancer incidence in Tehran metropolis: the first report from the Tehran population-based cancer registry. Arch Iran Med, 12, 15-23.
  26. Kontodimopoulos N, Samatizis A, Papadopoulos AA et al (2012). Reliability and validity of the Greek QLQ-C30 and QLQ-MY20 for measuring quality of life in patients with multiple myeloma. Scientific World Journal, 2012, 842867.
  27. Kamangar F, Malekzadeh R, Dawsey S, et al (2007). Esophageal cancer in Northeastern Iran: a review. Arch Iran Med, 10, 70-82.
  28. Kiebert G, Wait S, Bernhard J, et al (2000). Practice and policy of measuring quality of life and health economics in cancer clinical trials: a survey among co-operative trial groups. Qual Life Res, 9, 1073-80.
  29. Koller M, Aaronson NK, Blazeby J, et al (2007). Translation procedures for standardised quality of life questionnaires: The European Organisation for Research and Treatment of Cancer (EORTC) approach. Eur J Cancer, 43, 1810-20.
  30. Ku GY, Ilson DH (2012). Adjuvant therapy in esophagogastric adenocarcinoma: controversies and consensus. Gastrointest Cancer Res, 5, 85-92.
  31. Lagergren P, Fayers P, Conroy T, et al (2007). Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-OG25, to assess health-related quality of life in patients with cancer of the oesophagus, the oesophagogastric junction and the stomach. Eur J Cancer, 43, 2066-73.
  32. Fayers P, Bottomley A (2002). Quality of life research within the EORTC-the EORTC QLQ-C30. Eur J Cancer, 38, 125-33.
  33. Esmaeili-Hesari RA, Homai-Shandiz F, Motevallian A, et al (2012). Do clinical and demographic features of patients with upper-gastrointestinal cancer affect their health-related quality of life? Int J Prev Med, 3, 783-90.
  34. Farooqui M, Hassali MA, Knight A, et al (2012). Cross sectional assessment of health related quality of life among patients with cancer in Malaysia. Asian Pac J Cancer Prev, 14, 3017-21.
  35. Fayers P, Aronson N, Bjordal K, et al (2001). The EORTC QLQ-C30 Scoring Manual European Organization for Research and Treatment of Cancer. Brussels, Belgium.
  36. Ferrans CE (2010). Advances in measuring Quality of life outcom in cancer care. Advances in measuring Quality of life outcom in cancer care, Semin Oncol Nurs, 26, 2-11.
  37. Hasegawa S, Yoshikawa T (2010). Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric Cancer, 13, 63-73.
  38. Hoopman R, Muller M, Terwee C, Aaronson N (2006). Translation and validation of the EORTC QLQ-C30 for use among Turkish and Moroccan ethnic minority cancer patients in the Netherlands. Eur J Cancer, 42, 1839-47.
  39. Aronson NK, Ahmadzai S, Bergman B, et al (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 85, 365-76.
  40. Alawadhi SA, Ohaeri JU (2010). Validity and reliability of the European Organization for Research and Treatment in Cancer Quality of Life Questionnaire (EORTC QLQ): experience from Kuwait using a sample of women with breast cancer. Ann Saudi Med, 30, 390-6.
  41. Asadi-Lari M, Tamburini M, GRAY D (2004). Patients' needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes, 2, 32.
  42. Camargo MC, Anderson WF, King JB, et al (2011). Divergent trends for gastric cancer incidence by anatomical subsite in US adults. Gut, 60, 1644-9.
  43. Cheng J, Liu B, Zhang X, et al (2011). The validation of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) in pre-operative patients with brain tumor in China. BMC Med Res Methodol, 11, 56.
  44. Dikshit RP, Mathur G, Mhatre S, et al (2011). Epidemiological review of gastric cancer in India. Indian J Med Paediatr Oncol, 32, 3-11.
  45. Edeg SB, Compton CC (2010). The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 17, 1471-4.