开发乳房效用仪器，一种基于偏好的工具，用于测量乳腺癌女性的健康相关生活质量：EORTC QLQ-C30 和 BR45 的验证性因子分析，以确定维度。
Developing the Breast Utility Instrument, a preference-based instrument to measure health-related quality of life in women with breast cancer: Confirmatory factor analysis of the EORTC QLQ-C30 and BR45 to establish dimensions.
机构信息
Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.
Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
出版信息
PLoS One. 2022 Feb 4;17(2):e0262635. doi: 10.1371/journal.pone.0262635. eCollection 2022.
OBJECTIVES
Breast cancer (BrC) and its treatments impair health-related quality of life (HRQoL). Utility is a measure of HRQoL that includes preferences for health outcomes, used in treatment decision-making. Generic preference-based instruments lack BrC-specific concerns, indicating the need for a BrC-specific preference-based instrument. Our objective was to determine dimensions of the European Organisation for Research and Treatment of Cancer (EORTC) general cancer (QLQ-C30) and breast module (BR45) instruments, the first step in our development of the novel Breast Utility Instrument (BUI).
METHODS
Patients (n = 408) attending outpatient BrC clinics at an urban cancer centre, and representing a spectrum of BrC health states, completed the QLQ-C30 and BR45. We performed confirmatory factor analysis of the combined QLQ-C30 and BR45 using mean-and variance-adjusted unweighted least squares estimation. The hypothesized factor model was based on clinical relevance, item distributions, missing data, item-importance, and internal reliability of dimensions. Models were evaluated based on global and item fit, local areas of strain, and likelihood ratio tests of nested models.
RESULTS
Our final model had 10 dimensions: physical and role functioning, emotional functioning, social functioning, body image, pain, fatigue, systemic therapy side effects, sexual functioning and enjoyment, arm and breast symptoms, and endocrine therapy symptoms. Good overall model fit was achieved: χ2/df: 1.45, Tucker-Lewis index: 0.946, comparative fit index: 0.951, standardized root-mean-square residual: 0.069, root-mean-square error of approximation: 0.033 (0.030-0.037). All items had salient factor loadings (λ>0.4, p<0.001).
CONCLUSIONS
We identified important BrC HRQoL dimensions to develop the BUI, a BrC-specific preference-based instrument.
目的
乳腺癌（BrC）及其治疗会损害健康相关生活质量（HRQoL）。效用是 HRQoL 的一种衡量标准，包括对健康结果的偏好，用于治疗决策。通用偏好量表缺乏针对 BrC 的具体问题，表明需要开发一种针对 BrC 的特定偏好量表。我们的目的是确定欧洲癌症研究与治疗组织（EORTC）一般癌症（QLQ-C30）和乳房模块（BR45）工具的维度，这是开发新型乳房效用工具（BUI）的第一步。
方法
在城市癌症中心的门诊 BrC 诊所就诊的患者（n=408），代表了一系列 BrC 健康状况，完成了 QLQ-C30 和 BR45。我们使用均值和方差调整的未加权最小二乘估计对合并的 QLQ-C30 和 BR45 进行验证性因素分析。假设的因素模型基于临床相关性、项目分布、缺失数据、项目重要性和维度的内部可靠性。根据全局和项目拟合、局部应变区域以及嵌套模型的似然比检验来评估模型。
结果
我们的最终模型有 10 个维度：身体和角色功能、情绪功能、社会功能、身体形象、疼痛、疲劳、系统治疗副作用、性功能和享受、手臂和乳房症状以及内分泌治疗症状。模型整体拟合良好：χ2/df：1.45，Tucker-Lewis 指数：0.946，比较拟合指数：0.951，标准化均方根残差：0.069，均方根误差近似值：0.033（0.030-0.037）。所有项目都有明显的因子负荷（λ>0.4，p<0.001）。
结论
我们确定了重要的 BrC HRQoL 维度来开发 BUI，这是一种针对 BrC 的特定偏好量表。
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