Comparing FACT and EORTC QLQ modules for the assessment of quality of life in patients with hepatobiliary cancers

Four commonly used quality of life (QoL) questionnaires for patients with hepatobiliary cancers are the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Liver Module (QLQ-LMC21), the Quality of Life Questionnaire Hepatocellular Carcinoma-Specific Module (QLQ-HCC18), the Quality of Life Questionnaire Biliary Tract Cancer and Gallbladder Cancer Module (QLQ-BIL21), and the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep). The objective of this systematic review is to compare the characteristics and psychometric properties of these four QoL instruments.

From 276 studies, 14 were included: QLQ-LMC21 (3), QLQ-HCC18 (6), QLQ-BIL21 (2), and FACT-Hep (3). All were rigorously developed using a multiphase, standardised approach and shown to be psychometrically valid. In the development/validation of the QLQ-LMC21 and QLQ-BIL21, a majority of patients were recruited from European countries, but race was not specified. In contrast, the QLQ-HCC18, despite including a greater proportion of East Asian participants, lacked representation from other regions and races. Furthermore, challenges in assessing jaundice in Asian patients were identified during the validation phase. The FACT-Hep was developed in the United States and only validated in the United States (90% Caucasian) and China. Notably, QLQ-BIL21 was limited by its small sample size ( n = 52) during the Phase III of its development.

The EORTC QLQ-LMC21, QLQ-HCC18, QLQ-BIL21, and FACT-Hep have proven to be reliable, valid, and responsive. However, additional cross-cultural validation studies may enhance global applicability.