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Are Preference-Weighted Cancer-Specific Measures More Sensitive Than Generic Measures? A Comparison of EQ-5D-5L,
Xin Zhang1, Mengting Ji2, Luying Wang3
1Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Objectives:
To compare the psychometric performance of generic EuroQol 5-Dimension 5-Level instrument (EQ-5D-5L), Short Form 6-Dimension version 2 (SF-6Dv2), cancer-specific Functional Assessment of Cancer Therapy Eight Dimension (FACT-8D) and the European Organization for Research and Treatment of Cancer Quality of Life Utility - Core 10 Dimensions (QLU-C10D) in gastric, pancreatic, and colorectal cancers.
Methods:
Patients recruited from a tertiary hospital in Shanghai, China, assessed their health using preference-weighted measures (PWMs) during 2 consecutive visits. Clinical data were extracted from medical records. Known-group validity, responsiveness, and agreement were assessed. PWMs' index scores were computed using Chinese value sets.
Results:
The analysis included 170 gastric, 142 pancreatic, and 207 colorectal cancer patients. Eastern Cooperative Oncology Group (ECOG) status of 1 was most common (82.4%-83.5%), and stage-IV predominated (60.0%-65.5%) across 3 cancers. EQ-5D-5L showed strongest known-group validity for ECOG status (Cohen's d: 1.87, 1.01, 1.73 for gastric, pancreatic, and colorectal cancers, respectively), followed by QLU-C10D (1.33, 1.22, 1.44), SF-6Dv2 (1.37, 1.00, 1.11), and FACT-8D (0.71, 0.72, 1.25). PWMs generally discriminated between early (0-III) and advanced (IV) stages; effect sizes were small or negligible, though SF-6Dv2 and FACT-8D failed for colorectal cancer. PWMs showed similar responsiveness to improvement across cancers, with standardized response means (SRMs) larger in pancreatic (range: 0.32 to 0.81) than colorectal (-0.07 to 0.45) or gastric cancers (0.00 to 0.51). Their responsiveness to deterioration varied by cancer type: in colorectal cancer, FACT-8D produced larger SRMs (-0.53 to -0.83) and QLU-C10D the greatest variation (-0.34 to -0.92); in gastric cancer, SF-6Dv2 had higher SRMs (-0.45 to -1.22) than others (-0.29 to -0.74); in pancreatic cancer, SRMs were comparable across PWMs. Agreement between PWMs was poor to moderate (intraclass correlation coefficient: 0.42 to 0.75).
Conclusions:
This study suggests that cancer-specific PWMs are not necessarily more sensitive than generic PWMs. Psychometric performance of these PWMs varies by cancer type. Their suboptimal agreement limits interchangeability.
