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The methodological quality of Patient-Reported Outcome Measures for Radiotherapy Induced Xerostomia in Head and Neck Cancer

Assas, Motaz B.; (2020) The methodological quality of Patient-Reported Outcome Measures for Radiotherapy Induced Xerostomia in Head and Neck Cancer. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Radiotherapy-induced xerostomia (RIX) is the most commonly experienced late stage adverse effect of radiotherapy of head and neck malignancy. RIX can influence a patient’s restoration of oral function, adversely affect their quality of life and possibly their prognosis. Knowledge of the severity of RIX is relevant as it can guide treatment. Measuring RIX can be done either objectively or subjectively. When measuring RIX subjectively, this is best performed with a patient-reported outcome measure (PROM). PROMs may be an effective tool in assessing xerostomia. However, to ensure that data captured by a PROM is trustworthy and can be used in reporting on the symptom with confidence, the PROM should have been appropriately validated. The aim is to identify high quality PROMs that measure RIX outcomes in order to be recommended for use on a population residing in England. After applying the COSMIN guidelines, this was performed by a systematic review that identified four RIX-specific PROMs (XQ, XI, GRIX and XeQoLS). All four PROMs were found to have methodological shortcomings in their validations. A qualitative study including focus group interviews, was performed to select the most suitable PROMs among the four PROMs, the XI and XeQoLS were then selected. The XI and XeQoLS were tested for their validity and reliability on a sample of 75 RIX patients with HNC residing in England. Both PROMs had an acceptable overall score for internal consistency (α = 0.951 and α =0.839 respectively). Structural validity; factor analysis, was below the acceptable score; XI (TLI= 0.632 and CFI=0.755 < 0.95) and XeQoLS (TLI= 0.838 CFI= 0.887< 0.95). Hypothesis testing score between both PROMs was a Spearman’s correlation score of 0.74, this suggests an accordance with the tested hypothesis. Test-retest reliability was performed by calculating weighted kappa, scores for XI and XeQoLS (k = 0.484 and k = 0.473), these scores are considered good or fair scores (0.4 to 0.75). XI and XeQoLS questionnaires are therefore validly and reliably able to measure xerostomia outcomes in RIX patients with HNC residing in the England, based on their current construct. However there is a need for structural validity to be evaluated in a larger sample size.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The methodological quality of Patient-Reported Outcome Measures for Radiotherapy Induced Xerostomia in Head and Neck Cancer
Event: ucl
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10108773
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