Investigating the response scale of the EORTC QLQ-C30 in German cancer patients and a population survey

Abstract Background The European Organization for research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) scales are scored on a 4-point response scale, ranging from not at all to very much. Previous studies have shown that the German translation of the response option quite a bit as mäßig violates interval scale assumptions, and that ziemlich is a more appropriate translation. The present studies investigated differences between the two questionnaire versions. Methods The first study employed a balanced cross-over design and included 450 patients with different types of cancer from three German-speaking countries. The second study was a representative survey in Germany including 2033 respondents. The main analyses included compared the ziemlich and mäßig version of the questionnaire using analyses of covariance adjusted for sex, age, and health burden. Results In accordance with our hypothesis, the adjusted summary score was lower in the mäßig than in the ziemlich version; Study 1: − 4.5 (95% CI − 7.8 to − 1.3), p = 0.006, Study 2: − 3.1 (95% CI − 4.6 to − 1.5), p < 0.001. In both studies, this effect was pronounced in respondents with a higher health burden; Study 1: − 6.8 (95% CI − 12.2 to − 1.4), p = 0.013; Study 2: − 4.5 (95% CI − 7.3 to − 1.7), p = 0.002. Conclusions We found subtle but consistent differences between the two questionnaire versions. We recommend to use the optimized response option for the EORTC QLQ-C30 as well as for all other German modules. Trial registration: The study was retrospectively registered on the German Registry for Clinical Studies (reference number DRKS00012759, 04th August 2017, https://www.drks.de/DRKS00012759).

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Investigating the Response Scale of the Eortc Qlq-C30 in German Cancer Patients and a Population Survey – A Case of Quality Control in Patient-Reported Outcomes Research

10.21203/rs.3.rs-533959/v1 ◽

2021 ◽

Author(s):

Michael Koller ◽

Karolina Müller ◽

Sandra Nolte ◽

Heike Schmidt ◽

Christina Harvey ◽

...

Keyword(s):

Summary Score ◽

Life Questionnaire ◽

Response Scale ◽

European Organization ◽

Response Option ◽

Health Burden ◽

Patient Reported ◽

Symptom Ratings ◽

Eortc Qlq C30 ◽

Eortc Qlq

Abstract Background: The European Organization for research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) scales are scored on a 4-point response scale, ranging from not at all to very much. Previous studies have shown that the German translation of the response option quite a bit as mäßig violates interval scale assumptions, and that ziemlich is a more appropriate translation. The present studies investigated differences between the two questionnaire versions and were based on the hypothesis that the conventional version yielded lower functioning and higher symptom ratings than the optimized version, particularly in respondents with a higher health burden.Methods: The first study employed a balanced cross-over design and included 450 patients with different types of cancer from three German-speaking countries. The second study was a representative survey in Germany including 2033 respondents. Half of the participants filled in the mäßig, the other half the ziemlich version of the questionnaire.Results: In accordance with our hypothesis, the adjusted summary score was lower in the mäßig than in the ziemlich version; Study 1: -4.5 (95% CI -7.8 to -1.3), p = 0.006, Study 2: -3.1 (95% CI - 4.6 to -1.5), p < 0.001. In both studies, this effect was pronounced in respondents with a higher health burden; Study 1: -6.8 (95% CI -12.2 to -1.4), p = 0.013; Study 2: -4.5 (95% CI -7.3 to -1.7), p = 0.002.Conclusions: We found subtle but consistent differences between the two questionnaire versions. The optimized response option should be used for the EORTC QLQ-C30 as well as for all other German modules.Trial registration: The study was retrospectively registered on the German Registry for Clinical Studies (reference number DRKS00012759, 04th August 2017, https://www.drks.de/DRKS00012759).

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Psychometric properties of the EORTC Quality of Life Questionnaire in inpatient cancer rehabilitation in Germany

Palliative & Supportive Care ◽

10.1017/s1478951504040179 ◽

2004 ◽

Vol 2 (2) ◽

pp. 115-124 ◽

Cited By ~ 6

Author(s):

JÖRG DIRMAIER ◽

SILKE ZAUN ◽

UWE KOCH ◽

TIMO HARFST ◽

HOLGER SCHULZ

Keyword(s):

Quality Of Life ◽

Psychometric Properties ◽

Cancer Patients ◽

Scale Structure ◽

Cancer Rehabilitation ◽

Life Questionnaire ◽

European Organization ◽

Eortc Qlq C30 ◽

Eortc Qlq

Objective: Recent years have shown an increase in the use of questionnaires measuring health-related quality of life to verify the quality of treatment in the field of oncology. An often used cancer-specific questionnaire is the “Quality of Life Core Questionnaire of the European Organization for the Research and Treatment of Cancer” (EORTC QLQ-C30). The purpose of this study is to analyze the psychometric properties of the EORTC QLQ-C30 (version 1) in order to determine the feasibility and appropriateness for its use in inpatient cancer rehabilitation in Germany with heterogeneous diagnoses.Methods: The questionnaire was administrated to a sample of 972 cancer patients at the beginning of treatment and to 892 patients after treatment. Besides descriptive analysis, the statistical analyses include confirmatory analysis and the multitrait/multimethod approach to test the questionnaire's postulated scale structure (factorial validity) and its reliability (internal consistencies). The analysis also includes a comparison of responsiveness indices (effect size, reliable change index) to test the sensitivity of the instrument.Results: The EORTC QLQ-C30 showed satisfactory levels of reliability and sensitivity, but the postulated scale structure could not be confirmed. The results illustrate that the varimax-rotated solution of a principal component analysis does not confirm the scale structure postulated by the authors. Correspondingly, the selected fit indices within the scope of the confirmatory factor analysis do not show satisfactory results either.Significance of results: We therefore consider version 1 of the EORTC QLQ-C30 to be only limitedly useful for the routine assessment of changes in the quality of life of cancer patients in inpatient rehabilitation in Germany, especially because of the instrument's length and possible redundancies. For this reason, a scoring procedure limited to a subset of items is suggested, revealing satisfactory to good psychometric indices. However, further psychometric tests are necessary, especially with regard to validity and sensitivity.

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Avaliação da Qualidade de Vida e Prevalência de Sintomas Depressivos em Pacientes Oncológicos Submetidos à Radioterapia

Revista Brasileira de Cancerologia ◽

10.32635/2176-9745.rbc.2020v66n1.775 ◽

2020 ◽

Vol 66 (1) ◽

Author(s):

Antonio Augusto Claudio Pereira ◽

Nayara De Paula Passarin ◽

Jordana Henriques Coimbra ◽

Gabriela Grasso Pacheco ◽

Marcel Pereira Rangel

Keyword(s):

Quality Of Life ◽

Life Questionnaire ◽

European Organization ◽

Quality Of Life Questionnaire ◽

Eortc Qlq C30 ◽

Eortc Qlq

Introdução: A qualidade de vida de pacientes oncológicos tem sido objeto de estudo em muitos trabalhos brasileiros. Contudo, apesar da alta prevalência de indivíduos submetidos a radioterapia, poucos estudos com ênfase nesse grupo de pacientes foram identificados. Objetivo: Avaliar a qualidade de vida e a prevalência de sintomas depressivos em pacientes com neoplasias malignas durante o tratamento radioterápico. Método: Estudo transversal quantitativo realizado com 153 pacientes oncológicos em vigência de tratamento radioterápico em um centro especializado em oncologia e radioterapia, localizado no Noroeste do Estado do Parana. Os dados foram coletados entre marco e setembro de 2018. O European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) e o Inventario de Depressão de Beck foram utilizados para avaliar a qualidade de vida e os sintomas depressivos, respectivamente. Resultados: Os domínios “qualidade de vida”, “função cognitiva” e “função social” foram os que menos se mostraram prejudicados na amostra estudada, enquanto “insônia”, “perda de apetite” e “dificuldades financeiras” destacaram-se entre os maiores preditores de baixa qualidade de vida. Ademais, contatou-se que 22% dos indivíduos avaliados apresentaram algum grau de transtorno de humor, sendo 11% diagnosticados com depressão. Conclusão: O declínio na qualidade de vida e a prevalência de sintomas depressivos em pacientes oncológicos, mesmo os em vigência de radioterapia, enaltecem a importância de intervenções precoces que visem a restabelecer a funcionalidade e o bem-estar.

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Evaluation of meaningful change in bowel move frequency for patients with carcinoid syndrome.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.583 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 583-583 ◽

Cited By ~ 1

Author(s):

Stacie Hudgens ◽

Jonathon Gable ◽

Matthew H. Kulke ◽

Emily Bergsland ◽

Lowell Brian Anthony ◽

...

Keyword(s):

Carcinoid Syndrome ◽

Tryptophan Hydroxylase ◽

Life Questionnaire ◽

Meaningful Change ◽

Pivotal Phase ◽

European Organization ◽

Gi Symptoms ◽

Patient Reported ◽

Eortc Qlq C30 ◽

Eortc Qlq

583 Background: Telotristat ethyl is a tryptophan hydroxylase inhibitor in development for the treatment of carcinoid syndrome (CS) in patients who receive somatostatin analog (SSA) therapy. In TELESTAR, a pivotal Phase 3 study, telotristat ethyl significantly reduced bowel movement (BM) frequency compared to placebo. Objective: The objective of this study was to psychometrically assess meaningful change in BM frequency using data collected within the TELESTAR study. Methods: An anchor-based approach consisted of mapping change from baseline in BM frequency to other patient reported assessments of change. These included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core Questionnaire (EORTC QLQ-C30) Diarrhea Symptom responders, the EORTC GI.NET21 GI Symptom responders, and patient reported adequate relief at Week 12 (responders had a ≥ 10-point decrease in scores from Day 1 to Week 12). Parameters included within group mean change from baseline to Week 12, t-tests of the change (Wilcoxon Rank Sum for adequate relief), effect size (ES: calculated as the difference between mean on-treatment and baseline BM frequency, divided by the standard deviation of the baseline), and related confidence intervals. Results: There were 135 patients with CS, with a mean age of 63.6 years and mean baseline BM frequency of 5.7 BM/day. Anchor-based analyses indicated significant differences in BM frequency between adequate relief groups at Week 12 (ES: -1.58 vs. -0.79; p = 0.014), responders and non-responders on the EORTC QLQ-C30 Diarrhea Symptoms domain (ES: -1.24 vs. -0.59; p < 0.0001), and responders and non-responders on the EORTC GI.NET21 GI Symptoms Domain (ES: -1.49 vs. -0.75; p = 0.0053). These corresponded to BM frequency reductions of 1.7-1.9 BM/day, or ≥ 30%. Conclusions: Results of this study indicated that patients with CS experienced clinically meaningful reductions in BM frequency of ≥ 30% over the course of 12 weeks.

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Qualidade de Vida Relacionada à Saúde de Pacientes com Câncer de Mama: Revisão Integrativa da Literatura

Revista Brasileira de Cancerologia ◽

10.32635/2176-9745.rbc.2020v66n1.405 ◽

2020 ◽

Vol 66 (1) ◽

Author(s):

Monique Binotto ◽

Gilberto Schwartsmann

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cáncer De Mama ◽

Life Questionnaire ◽

European Organization ◽

Quality Of Life Questionnaire ◽

Cancer Breast ◽

Eortc Qlq C30 ◽

Eortc Qlq

Introdução: O câncer de mama pode alterar a qualidade de vida relacionada à saúde das pacientes. Objetivo: Compreender o impacto da quimioterapia para câncer de mama na qualidade de vida relacionada à saúde de pacientes. Método: Trata-se de uma revisão integrativa da literatura, compreendendo artigos publicados entre 2007 e 2019, disponíveis nas bases de dados PubMed, LILACS e SciELO. Analisaram-se 25 artigos na íntegra. Resultados: Os questionários mais frequentemente utilizados nos estudos foram o European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) e o módulo complementar European Organization for Research and Treatment of Cancer Breast Cancer-specific Quality of Life Questionnaire (EORTC QLQ-BR23). Em relação às alterações da qualidade de vida, a saúde global diminui durante a quimioterapia, mas pode melhorar após o término do tratamento. O aumento dos sintomas é relatado em diversos estudos e prejudicou a qualidade de vida relacionada à saúde das pacientes. Entretanto, os sintomas diminuem após o término da quimioterapia, exceto para algumas escalas. As escalas de imagem corporal, função sexual e funcionamento físico pioram ao longo do tratamento. A qualidade de vida mental/psicológica tem oscilações durante o tratamento, assim como a escala sobre as relações sociais. Conclusão: A qualidade de vida relacionada à saúde de mulheres com câncer de mama é afetada negativamente pelo tratamento quimioterápico, expressando maior impacto nas escalas de sintomas.

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Test/retest study of the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.5.1249 ◽

1995 ◽

Vol 13 (5) ◽

pp. 1249-1254 ◽

Cited By ~ 248

Author(s):

M J Hjermstad ◽

S D Fossa ◽

K Bjordal ◽

S Kaasa

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Reliability And Validity ◽

Life Questionnaire ◽

European Organization ◽

Retest Reliability ◽

Eortc Qlq C30 ◽

Eortc Qlq ◽

Test Retest Reliability

PURPOSE The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) is a well-validated instrument that assesses health-related quality of life (HRQOL) in cancer patients. It is used in cancer clinical trials in Europe, Canada, and the United States, and has demonstrated high reliability and validity in different groups of cancer patients. Despite thorough testing of reliability and validity, we have not identified any reports on its test/retest reliability; thus, a test/retest study was performed at the Norwegian Radium Hospital (NRH). MATERIALS AND METHODS Cancer patients from the outpatient clinic who were off treatment for > or = 3 months were eligible for the study. The EORTC QLQ-C30 was given to the patients when they presented for their visit. The second questionnaire was received by the patients 4 days later. Of 291 eligible patients, 270 (93%) agreed to participate and 190 (73%) completed both questionnaires. RESULTS The test/retest reliability measured by Pearson's correlation coefficient was high for all functional scales, with a range from .82 for cognitive and role function to .91 for physical function. The r value for global HRQOL was .85. For the symptom scales--nausea/vomiting, fatigue, and pain--the coefficients were .63, .83, and .86, respectively. The single-item coefficients ranged from .72 for diarrhea to .84 for financial impact. The Spearman rank correlation was in the same range for all dimensions. CONCLUSION The EORTC QLQ-C30 seems to yield high test/retest reliability in patients with various cancer diagnoses whose condition is not expected to change during the time of measurement.

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Quality of life among Ethiopian cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-020-05398-w ◽

2020 ◽

Vol 28 (11) ◽

pp. 5469-5478

Author(s):

Yemataw Wondie ◽

Andreas Hinz

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Depression Scale ◽

Developed Countries ◽

Anxiety And Depression ◽

Life Questionnaire ◽

European Organization ◽

Eortc Qlq C30 ◽

Eortc Qlq

Abstract Purpose Cancer is of increasing prevalence in less-developed countries. However, research on the patients’ quality of life (QoL) in these countries is very limited. The aim of this study was to examine QoL of cancer patients in Africa. Method A sample of 256 cancer patients treated in an Ethiopian hospital was examined with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, the Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale. A group of 1664 German cancer patients served as a comparison group. Results Most of the scales of the EORTC QLQ-C30 showed acceptable reliability in the Ethiopian sample. Compared with the German cancer patients, the Ethiopian patients showed lower QoL in most dimensions, especially in financial difficulties, physical functioning, pain, and appetite loss (effect sizes between 0.52 and 0.75). Illiteracy, tumor stage, and treatment (surgery and chemotherapy) were associated with QoL in the Ethiopian sample. QoL was strongly correlated with fatigue, anxiety, and depression. Conclusion The EORTC QLQ-C30 is a suitable instrument for measuring QoL in Ethiopia. The detriments in QoL in the Ethiopian patients indicate specific cancer care needs for the patients in a developing country.

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Quality of Life in a Randomized Trial of Group Psychosocial Support in Metastatic Breast Cancer: Overall Effects of the Intervention and an Exploration of Missing Data

Journal of Clinical Oncology ◽

10.1200/jco.2003.04.080 ◽

2003 ◽

Vol 21 (10) ◽

pp. 1944-1951 ◽

Cited By ~ 89

Author(s):

Louise Bordeleau ◽

John Paul Szalai ◽

Marguerite Ennis ◽

Molyn Leszcz ◽

Michael Speca ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Metastatic Breast Cancer ◽

Missing Data ◽

Metastatic Breast ◽

Life Questionnaire ◽

European Organization ◽

Eortc Qlq C30 ◽

Eortc Qlq

Purpose: To evaluate the effect of a standardized group psychosocial intervention on health-related quality of life (HrQOL) in women with metastatic breast cancer and to explore the effect of missing data in HrQOL analyses. Patients and Methods: Between 1993 and 1998, seven Canadian centers randomly assigned 235 eligible women to participate in a weekly, 90-minute, therapist-led support group that adhered to principles of supportive-expressive (SE) therapy or to a control arm (no SE). All women received educational material and any type of medical or psychosocial care deemed necessary. HrQOL data were prospectively collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) at baseline, 4, 8, and 12 months. The primary HrQOL analyses compared scores in the two study arms. Analyses were limited to women with appropriate baseline HrQOL information (n = 215). Results: Baseline EORTC QLQ-C30 scores were not different between the two study arms (all P > .05). Primary analysis of all subscales failed to show a significant influence of the intervention on HrQOL (all P > .05). There was a significant deterioration over time in several functional scales of the EORTC QLQ-C30: global (P = .03), physical (P = .0002), role (P = .01), and cognitive functioning (P = .04); and in symptom scales: dyspnea (P = .007), appetite loss (P = .04), and fatigue (P = .003); these changes were independent of randomization allocation. Results were similar in additional analyses of overall HrQOL using a variety of approaches to handling missing data. Conclusion: Supportive-expressive group therapy in patients with metastatic breast cancer does not appear to influence HrQOL, as measured by the EORTC QLQ-C30.

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Penilaian kualitas hidup penderita karsinoma nasofaring berdasarkan Karnofsky Scale, EORTC QLQ-C30 dan EORTC QLQ-H & N35

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v43i2.68 ◽

2014 ◽

Vol 43 (2) ◽

pp. 110

Author(s):

Dewi Kurniawati ◽

Frederik George Kuhuwael ◽

Abdul Qadar Punagi

Keyword(s):

Quality Of Life ◽

Karnofsky Performance Scale ◽

Life Questionnaire ◽

Cross Sectional ◽

European Organization ◽

Quality Of Life Questionnaire ◽

Eortc Qlq C30 ◽

Eortc Qlq ◽

Performance Scale

Latar belakang: Karsinoma nasofaring (KNF) berpengaruh terhadap kualitas hidup penderita, baik dari kankernya sendiri, maupun pengobatan serta efek sampingnya. Penilaian kualitas hidup penderita KNF dapat secara unidimensional menggunakan parameter status tampilan Karnofsky Performance Scale (Karnofsky PS) atau multidimensional memakai parameter European Organization For Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) dan European Organization For Research And Treatment Of Cancer Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H&N35).Tujuan: Menilai kesesuaian hasil skor Karnofsky PS, EORTC QLQ-C30 dan EORTC QLQ-H&N35 dalam menilai kualitas hidup penderita KNF dengan menentukan korelasi antar parameter dan menentukan estimasi skor Karnofsky PS menggunakan skor EORTC QLQ-C30 dan skor EORTC QLQ-H&N35. Menganalisis hubungan antar parameter menurut stadium.Metode: Penelitian adalah observasional analitik dengan pedekatan cross sectional. Populasinya semua kasus KNF yang berobat ke Bagian THT-KL, Rumah Sakit Wahidin Sudirohusodo, Makassar. Sampel sebanyak 48 orang dipilih secara purposive. Penilaian kualitas hidup menggunakan parameter Karnofsky PS, EORTC QLQ-C30 dan EORTC QLQ-H&N35. Hasil: Didapati kesesuaian hasil skor dari ketiga parameter, ditandai adanya korelasi bermakna antara skor Karnofsky PS, skor EORTC QLQ-C30 dan skor EORTC QLQ-H&N35. Semakin tinggi skor Karnofsky PS, akan semakin rendah skor EORTC QLQ-C30 dan skor EORTC QLQ-H&N35 maka kualitas hidup penderita KNF semakin baik. Skor EORTC QLQ-C30 dan skor EORTC QLQ-H&N35 dapat mengestimasi skor Karnofsky PS. Terdapat hubungan bermakna antara Karnofsky PS, EORTC QLQ-C30 dan EORTC QLQ-H&N35 menurut stadium (p<0,05). Kesimpulan: DEORTC QLQ-C30 dan EORTC QLQ-H&N35 dapat melengkapi Karnofsky PS dalam penilaian kualitas hidup penderita kanker kepala leher terutama KNF. Kata kunci: Kualitas hidup, KNF, Karnofsky PS, EORTC QLQ-C30, EORTC QLQ-H&N3.

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Translation and validation of the Urdu version of the European organization for research and treatment of cancer core quality of life questionnaire (EORTC QLQ-C30) and brain module (QLQ-BN20) in primary brain tumor patients

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00354-6 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Nida Zahid ◽

Russell Seth Martins ◽

Wajeeha Zahid ◽

Wardah Khalid ◽

Iqbal Azam ◽

...

Keyword(s):

Quality Of Life ◽

Brain Tumors ◽

Tertiary Care ◽

Life Questionnaire ◽

Care Hospital ◽

European Organization ◽

Primary Brain Tumors ◽

Eortc Qlq C30 ◽

Eortc Qlq

Abstract Introduction This study translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (EORTC QLQ-C30) and Brain Module (QLQ-BN20) amongst patients with primary brain tumors (PBT) in Pakistan, and assessed the correlation of QoL with resilience, depression, and anxiety. Methods Translation of the EORTC QLQ-C30 and QLQ-BN20 was performed as per EORTC guidelines. A survey comprising of Urdu translations of EORTC QLQ-C30, QLQ-BN20, Wagnild and Young Resilience Scale (RS-14) and Hospital Anxiety and Depression Scale was administered to patients with PBT at a tertiary care hospital in Pakistan. Reliability (via Cronbach alpha), content validity index (CVI) scores, construct validity, and inter-scale correlations were assessed. Results Our sample consisted of 250 patients with PBT, most commonly glioma (46.8%) and meningioma (21.2%). All patients were able to understand the Urdu translations. The Cronbach alphas for the QLQ-C30 and the QLQ-BN20 were 0.860 and 0.880, respectively. The CVI scores for clarity and relevance were high for both the EORTC QLQ-C30 (0.98 and 0.96, respectively) and the QLQ-BN20 tool (0.81 and 0.95, respectively). The global QoL domain (EORTC QLQ-C30) showed significant positive correlations with resilience (r = 0.422), and significant negative correlations with depression (r = − 0.541) and anxiety (r = − 0.502). Strong inter-scale correlations were observed between physical functioning and insomnia (r = − 0.690) and role functioning and insomnia (r = − 0.641). Conclusion Our study confirms the Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 as valid clinical tools for the measurement of QoL in primary brain tumors patients within the cultural and socioeconomic context of Pakistan.

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