Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Advertisement

British Journal of Cancer
  • View all journals
  • Search
  • My Account Login
  • Content Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • RSS feed
  1. nature
  2. british journal of cancer
  3. regular article
  4. article
Alternative methods of interpreting quality of life data in advanced gastrointestinal cancer patients
Download PDF
Download PDF
  • Regular Article
  • Open access
  • Published: 30 October 2001

Alternative methods of interpreting quality of life data in advanced gastrointestinal cancer patients

  • K Nordin1,
  • J Steel2,
  • K Hoffman2 &
  • …
  • B Glimelius2 

British Journal of Cancer volume 85, pages 1265–1272 (2001)Cite this article

  • 2063 Accesses

  • 64 Citations

  • Metrics details

This article has been updated

Abstract

Understanding of how to analyse and interpret quality of life (QoL) data from clinical trials in patients with advanced cancer is limited. In order to increase the knowledge about the possibilities of drawing conclusions from QoL data of these patients, data from 2 trials were reanalysed. A total of 113 patients with pancreatic, biliary or gastric cancer were included in 2 randomised trials comparing chemotherapy and best supportive care (BSC) with BSC alone. Patient benefit was evaluated by the treating physician (subjective response) and by using selected scales and different summary measures of the EORTC QLQ-C30 questionnaire. An increasing number of drop-outs (mainly due to death) with time did not occur in a random fashion. Therefore, the mean scores in the different subscales of the QLQ-C30 obtained during the follow-up of interviewed patients did not reflect the outcome of the randomised population. The scores of the patient-provided summary measure, ‘Global health status/QoL', were stable in a rather high proportion of the patients and could not discriminate between the 2 groups. 3 other summary measures revealed greater variability, and they all discriminated between the 2 groups. A high agreement was also seen between the changes in the summary measures and the subjective response. A categorisation of whether an individual patient had benefited or not from the intervention could overcome the problem with the selective attrition. © 2001 Cancer Research Campaign http://www.bjcancer.com

Similar content being viewed by others

Quality of life for patients with advanced gastrointestinal cancer randomised to early specialised home-based palliative care: the ALLAN trial

Article Open access 01 July 2024

Temporal stability of quality of life assessments in cancer patients

Article Open access 04 March 2021

The role of patient activation in mediating the effects of health literacy level on quality of life among patients with gastrointestinal cancers

Article Open access 01 March 2025

Article PDF

Change history

  • 16 November 2011

    This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication

References

  • Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB and Haes JCd (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in clinical trials in oncology. J Natl Cancer Inst 85: 365–376

    Article  CAS  Google Scholar 

  • Andrykowski M, Brady M and Hung J (1993) Positive psychological adjustment in potential bone marrow transplant recipients: Cancer as a psychosocial transition. Psycho-Oncol 2: 261–276

    Article  Google Scholar 

  • Bergman B, Sullivan M and Sörenson S (1991) Quality of life during chemotherapy for small cell lung cancer. I. An evaluation with generic health measures. Acta Oncol 30: 947–957

    Article  CAS  Google Scholar 

  • Bernhard J, Cella D, Coates A, Fallowfield L, Ganz P, Moinpour C, Mosconi P, Osboa D, Simes J and Hürny C (1998) Missing quality of life data in cancer clinical trials: serious problems and challenges. Stat Med 17: 517–532

    Article  CAS  Google Scholar 

  • Bernhard J, Hurny C, Maibach R, Herrmann R and Laffer U (1999) Quality of life as subjective experience: reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy. Swiss Group for Clinical Cancer Research (SAKK). Ann Oncol 10: 775–782

    Article  CAS  Google Scholar 

  • Bjordal K and Kaasa S (1992) Psychometric validation of the EORTC core quality of life questionnaire, 30-item version and a diagnosis-specific module for head and neck cancer patients. Acta Oncol 31: 311–321

    Article  CAS  Google Scholar 

  • Breetvelt I and Van Dam F (1991) Underreporting by cancer patients: The case of response shift. Social Science & Medicine 32: 981–987

    Article  CAS  Google Scholar 

  • Campell S and Whyte F (1999) Quality of life in cancer patients participating in phase I clinical trials using SEIQoL-DW. Methodological issues. Nursing Research 30: 335–343

    Google Scholar 

  • Cassileth B, Lusk E and Tenaglia A (1984) A psychological comparison of patients with melanoma and other dermatological disordes. Am Academy Dermatol 7: 742–746

    Article  Google Scholar 

  • Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J, Eckberg K, Lloyd S, Purl S, Blendowski C, Goodman M, Barnicle M, Stewart I, McHale M, Bonomi P, Kaplan E, IV ST, CR Thomas J and Harris J (1993) The functional assessment of cancer therapy scale: Development and validation of the general measure. J Clin Oncol 11: 570–579

    Article  CAS  Google Scholar 

  • Cox DR, Fitzpatrick R, Fletcher AE, Gore SM, Spiegelhalter DJ and Jones DR (1992) Quality-of-life assessment: Can we keep it simple?. J R Statist Soc 155: 353–393

    Article  Google Scholar 

  • Curran D, Fossa S, Aaronson N, Kiebert G, Keuppens E and Hall R (1997) Baseline quality of life of patients with advanced prostate cancer. Eur J Cancer 33: 1809–1814

    Article  CAS  Google Scholar 

  • de Haes JC, van Knippenberg FC and Neijt J (1990) Measuring psychological and physical distress in cancer patients: Structure and application of the Rotterdam Symptom Checklist. Br J Cancer 62: 1034–1038

    Article  CAS  Google Scholar 

  • Detmar SB, Aaronson NK, Wever LD, Muller M and Schornagel JH (2000) How are you feeling? Who wants to know? Patients' and oncologists' preferences for discussing health-related quality-of-life issues. J Clin Oncol 18: 3295–3301

    Article  CAS  Google Scholar 

  • Diggle P and Kenward MG (1994) Informative drop-out in longitudinal data analysis. Appl Statist 43: 49–93

    Article  Google Scholar 

  • Fayers P, Aaronson N, Bjordal K and M Sullivan (1995) EORTC QLQ-C30 Scoring Manual. EORTC Quality of Life Study Group: 1–25

  • Fayers PM, Hopwood P, Harvey A, Girling DJ, Machin D and Stephens R (1997) On behalf of the MRC Cancer Trials Office. Quality of life assessment in clinical trials–Guidelines and a checklist for protocol writers: the U.K. Medical Research Council Experience. Eur J Cancer 33: 20–28

    Article  CAS  Google Scholar 

  • Glimelius B, Hoffman K, Olafsdottir M, Påhlman L, Sjödén P and Wennberg A (1989) Quality of life during cytostatic therapy for advanced symptomatic colorectal carcinoma. A randomized comparison of two regimens. Eur J Cancer Clin Oncol 25: 829–835

    Article  CAS  Google Scholar 

  • Glimelius B, Graf W, Hoffman K, Påhlman L, Sjödén PO and Wennberg A (1992) General condition of asymptomatic patients with advanced colorectal cancer receiving palliative chemotherapy: A longitudinal study. Acta Oncol 31: 645–651

    Article  CAS  Google Scholar 

  • Glimelius B, Hoffman K, Graf W, Påhlman L, Sjödén P-O and Wennberg A (1994) Quality of life during chemotherapy in symptomatic patients with advanced colorectal cancer. Cancer 73: 556–562

    Article  CAS  Google Scholar 

  • Glimelius B, Hoffman K, Sjödén P-O, Jacobsson G, Sellström H, Enander L-K, Linné T and Svensson C (1996) Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol 7: 593–600

    Article  CAS  Google Scholar 

  • Glimelius B, Ekström K, Hoffman K, Graf W, Sjödén P-O, Haglund U, Svensson C, Enander L-K, Linné T, Sellström H and Heuman R (1997) Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 8: 163–168

    Article  CAS  Google Scholar 

  • Guyatt GH, Veldhuyzen Van Zanten SJ, Feeny DH and Patrick DL (1989) Measuring quality of life in clinical trials: a taxonomy and review. CMAJ 140: 1441–1448

    CAS  PubMed  PubMed Central  Google Scholar 

  • Gunnars B, Nygren P and Glimelius B (2001) Assessment of quality of life during chemotherapy. Acta Oncol 40: 175–184

    Article  CAS  Google Scholar 

  • Hopwood P, Stephens RJ and Machin D (1994) Approaches to the analysis of quality of life data: experiences gained from a Medical Research Council Lung Cancer Working Party palliative chemotherapy trial. Qual Life Res 3: 339–352

    Article  CAS  Google Scholar 

  • Juniper EF, Guyatt GH, Willan A and Griffith LE (1994) Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 47: 81–87

    Article  CAS  Google Scholar 

  • Kaasa S, Mastekaasa A, Stokke I and Naess S (1988) Validation of a quality of life questionnaire for use in clinical trials for treatment of patients with inoperable lung cancer. Eur J Clin Oncol 24: 691–701

    Article  CAS  Google Scholar 

  • Labianca R, Pancera G and Luporini G (1996) Factors influencing response rates for advanced gastrointestinal cancer chemotherapy. Ann Oncol 7: 901–906

    Article  CAS  Google Scholar 

  • Lydick E and Epstein RS (1993) Interpretation of quality of life changes. Qual Life Res 2: 221–226

    Article  CAS  Google Scholar 

  • Matthews JNS (1993) A refinement to the analysis of serial data using summary measures. Stat Med 12: 27–37

    Article  CAS  Google Scholar 

  • Moinpour CM, Sawyers Triplett J, McKnight B, Lovato LC, Upchurch C, Leichman CG, Muggia FM, Tanaka L, James WA, Lennard M and Meyskens, Jr. FL (2000) Challenges posed by non-random missing quality of life data in an advanced-stage colorectal cancer clinical trial. Psychooncology 9: 340–354

    Article  CAS  Google Scholar 

  • Molenberghs G, Kenward MG and Lesaffre E (1997) The analysis of longitudinal ordinal data with nonrandom drop-out. Biometrika 84: 33–44

    Article  Google Scholar 

  • Morris J, Perez D and McNoe B (1998) The use of quality of life data in clinical practice. Qual Life Res 7: 85–91

    Article  CAS  Google Scholar 

  • Nordic Gastrointestinal Tumor Adjuvant Therapy Group (1993) Biochemical modulation of 5-fluorouracil: A randomized comparison of sequential methotrexate, 5-fluorouracil and leucovorin versus sequential 5-fluorouracil and leucovorin in patients with advanced symptomatic colorectal cancer. Ann Oncol 4: 235–241

  • O'Boyle CA, McGee H, Hickey A, O'Malley K and Joyce CR (1992) Individual quality of life in patients undergoing hip replacement. Lancet 339: 1088–1091

    Article  CAS  Google Scholar 

  • Osboa D, Rodrigues G, Myles J, Zee B and Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16: 139–144

    Article  Google Scholar 

  • Ross PJ, Webb A, Cunningham D, Prediville J, Norman AR and Oates J (1997) Infusional 5-fluorouracil in the treatment of gastrointestinal cancers: The Royal Marsden Hospital experience. Ann Oncol 8: 111–115

    Article  CAS  Google Scholar 

  • Rothenberg aL, Moore MJ, Cripps MC, Andersen JS, Portenoy RK, Burris HA, Green MR, Tarassoff PG, Brown TD, Casper ES, Storniolo AM and Hoff DDV (1996) A phase II trial of gemcitabine in patients with 5-FU-refractory pancreas cancer. Ann Oncol 7: 347–353

    Article  CAS  Google Scholar 

  • Sanders C, Egger M, Donovan J, Tallon D and Frankel S (1998) Reporting on quality of life in randomised controlled trials: bibliographic study. BMJ 317: 1191–1194

    Article  CAS  Google Scholar 

  • Schag CAC, Ganz PA and Heinrich RL (1991) Cancer Rehabilitation Evaluation System-Short Form (CARES-SF): A cancer specific rehabilitation and quality of life instrument. Cancer 68: 1406–1413

    Article  CAS  Google Scholar 

  • Schipper H (1990) Quality of Life: Principles of the clinical paradigm. J Psychosocial Oncol 8: 171–185

    Article  Google Scholar 

  • Sigurdadóttir V, Bolund C and Sullivan M (1996) Quality of life evaluation by the EORTC questionnaire technique in patients with generalized malignant melanoma on chemotherapy. Acta Oncol 35: 149–159

    Article  Google Scholar 

  • Sprangers MA and Schwartz CE (1999) Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med 48: 1507–1515

    Article  CAS  Google Scholar 

  • Sprangers M, te Velde A and Aaronson N (1999a) The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). Eur J Cancer 35: 238–247

    Article  CAS  Google Scholar 

  • Sprangers M, Van Dam F, Broersn J, Lodder L, Wever L, Visser M, Oosterveld P and Smets E (1999b) Revealing response shift in longitudinal research on fatigue-the use of the thentest approach. Acta oncol 38: 709–718

    Article  CAS  Google Scholar 

  • Troxel A, Fairclough D, Curran D and Hahn E (1998) Statistical analysis of quality of life with missing data in cancer clinical trials. Stat Med 17: 653–666

    Article  CAS  Google Scholar 

  • Wilke H, Preusser P, Stahl M, Harstrick A, Meyer HJ, Achterrath W, Schmoll HJ and Seeber S (1991) Etoposide, folinic acid, and 5-fluorouracil in carboplatin-pretreated patients with advanced gastric cancer. Cancer Chemother Pharmacol 29: 83–84

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    K Nordin

  2. Department of Oncology, Radiology and Clinical Immunology, Akademiska Sjukhuset, Uppsala, Sweden

    J Steel, K Hoffman & B Glimelius

Authors
  1. K Nordin
    View author publications

    Search author on:PubMed Google Scholar

  2. J Steel
    View author publications

    Search author on:PubMed Google Scholar

  3. K Hoffman
    View author publications

    Search author on:PubMed Google Scholar

  4. B Glimelius
    View author publications

    Search author on:PubMed Google Scholar

Rights and permissions

From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

Reprints and permissions

About this article

Cite this article

Nordin, K., Steel, J., Hoffman, K. et al. Alternative methods of interpreting quality of life data in advanced gastrointestinal cancer patients. Br J Cancer 85, 1265–1272 (2001). https://doi.org/10.1054/bjoc.2001.2046

Download citation

  • Received: 02 March 2001

  • Revised: 22 June 2001

  • Accepted: 13 July 2001

  • Published: 30 October 2001

  • Issue date: 02 November 2001

  • DOI: https://doi.org/10.1054/bjoc.2001.2046

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

  • quality of life
  • advanced gastrointestinal cancer
  • palliation
  • EORTC QLQ-C30

This article is cited by

  • A comprehensive analysis of the association between anemia and systemic inflammation in older patients with cancer

    • Xi Zhang
    • Jia-Xin Huang
    • Ming-Hua Cong

    Supportive Care in Cancer (2024)

  • Changes in patients’ quality of life during radiotherapy and 1 month after treatment

    • Osamu Tanaka
    • Yuka Kunishima
    • Masayuki Matsuo

    memo - Magazine of European Medical Oncology (2019)

  • Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: a prospective risk factor and serial assessment analysis

    • Barbara Deschler
    • Gabriele Ihorst
    • Juergen Finke

    Bone Marrow Transplantation (2018)

  • Health-related quality of life among cancer patients in their last year of life: results from the PROFILES registry

    • Natasja J. H. Raijmakers
    • M. Zijlstra
    • L. V. van de Poll-Franse

    Supportive Care in Cancer (2018)

  • A Prospective Study of Patient Reported Outcomes in Pancreatic and Peri‐ampullary Malignancy

    • J. R. E. Rees
    • R. C. Macefield
    • J. M. Blazeby

    World Journal of Surgery (2013)

Download PDF

Advertisement

Explore content

  • Research articles
  • Reviews & Analysis
  • News & Comment
  • Current issue
  • Collections
  • Follow us on Twitter
  • Sign up for alerts
  • RSS feed

About the journal

  • Journal Information
  • Open access publishing
  • About the Editors
  • Contact
  • Special Issues
  • For Advertisers
  • Subscribe

Publish with us

  • For Authors & Referees
  • Language editing services
  • Open access funding
  • Submit manuscript

Search

Advanced search

Quick links

  • Explore articles by subject
  • Find a job
  • Guide to authors
  • Editorial policies

British Journal of Cancer (Br J Cancer)

ISSN 1532-1827 (online)

ISSN 0007-0920 (print)

nature.com sitemap

About Nature Portfolio

  • About us
  • Press releases
  • Press office
  • Contact us

Discover content

  • Journals A-Z
  • Articles by subject
  • protocols.io
  • Nature Index

Publishing policies

  • Nature portfolio policies
  • Open access

Author & Researcher services

  • Reprints & permissions
  • Research data
  • Language editing
  • Scientific editing
  • Nature Masterclasses
  • Research Solutions

Libraries & institutions

  • Librarian service & tools
  • Librarian portal
  • Open research
  • Recommend to library

Advertising & partnerships

  • Advertising
  • Partnerships & Services
  • Media kits
  • Branded content

Professional development

  • Nature Awards
  • Nature Careers
  • Nature Conferences

Regional websites

  • Nature Africa
  • Nature China
  • Nature India
  • Nature Japan
  • Nature Middle East
  • Privacy Policy
  • Use of cookies
  • Legal notice
  • Accessibility statement
  • Terms & Conditions
  • Your US state privacy rights
Springer Nature

© 2026 Springer Nature Limited