External validation of the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer colorectal (CR29) module: Monocentric study

Table 1 Patients clinical and demographic characteristics

Variables	Description
Age, mean ± SD	55.65 ± 12.87
Sex
Female	98 (44.5%)
Male	123 (55.5%)
Tumor location
Colon	78 (35%)
Rectum	139 (62%)
Neoadjuvant chemoradiotherapy
No	107 (54,6%)
Yes	89 (45,5%)
Definitive stoma
No	50 (22.6%)
Yes	171 (77.4%)
Adjuvant chemotherapya
Yes	91 (70%)
No	39 (30%)

^aMissing data in this variable.

Table 2 Quality of life scores according to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and Quality of Life Questionnaire-CR29 structure and reliability

Scaling/single-item name	n	Item No.	Mean	SD	Floor	Ceiling	Range	ICC
EORTC QLQ-CR29
All patients	221
Urinary frequency		31.32	39.89	33.46	26.2	10.9	0-100	0.961
Blood & mucus in stool		38.39	24.73	29.02	43.4	4.1	0-100	0.969
(F) Body image		45-47	77.82	24.83	1.8	38	0-100	0.950
Defecation/stoma problems		49–54	-	-	-	-	-
Urinary incontinence		33	20.96	32.22	64.7	7.2	0-100	0.982
Dysuria		34	20.66	31.30	63.3	6.8	0-100	0.950
Abdominal pain		35	30.61	34.12	48	8.6	0-100	0.922
Buttock pain		36	27.14	34.62	55.7	9	0-100	0.921
Bloated feeling		37	28.80	33.77	50.2	8.6	0-100	0.945
Dry mouth		40	24.58	34.14	60.2	8.6	0-100	0.979
Hair loss		41	16.44	29.57	71.5	5.9	0-100	0.968
Trouble with taste		42	20.51	32.89	67.0	8.1	0-100	0.975
(F) Anxiety		43	64.67	37.60	16.7	43.4	0-100	0.951
(F) Weight		44	75.56	32.66	8.1	56.6	0-100	0.960
Patients with stoma	50
Flatulence		49s	41.49	33.00	28.6	10.2	0-100	0.908
Leakage		50 s	42.17	36.49	32.7	16.3	0-100	0.889
Sore skin around stoma		51s	42.85	38.49	34.5	20.4	0-100	0.965
Bags change		52.53 s	18.36	22.62	49	2	0-83	0.969
Embarrassed		54s	45.56	43.09	41.8	29.1	0-100	0.956
Stoma care pb		55s	40.08	41.47	46.8	21.5	0-100	0.912
Stoma pb		49-54s	37.41	20.18	4.1	4.1	0-100	0.999
Patients without stoma	172
Flatulence		49	30.62	37.01	52.9	12.8	0-100	0.980
Faecal incontinence		50	26.16	37.38	61.6	14.0	0-100	0.970
Sore skin around anus		51	20.34	31.72	64.5	7.6	0-100	0.979
Stool frequency		52.53	29.65	32.33	38.4	7.6	0-100	0.977
Embarrassment		54	31.20	38.51	54.7	15.1	0-100	0.975
Defecation pb		49-54	28.79	25.84	16.1	0.7	0-100	0.969
Male	123
Sexual functioning		56	42.85	37.81	33	20.5	0-100	0.928
Impotence		57	38.18	38.79	40.9	20	0-100	0.966
Female	98
Sexual functioning		58	67.06	36.76	11.9	48.8	0-100	0.933
Dyspareunia		59	26.58	35.75	58.3	10.7	0-100	0.985
C30	221
Physical function		1 - 5	73.64	23.85	0.9	23.9	0-100	-
Role function		6.7	62.92	37.00	13.3	39.0	0-100	-
Emotional function		21-24	67.24	30.77	4.1	30.7	0-100	-
Cognitive function		20. 25	83.94	23.45	0.5	58.3	0-100	-
Social function		26 . 27	79.58	28.93	3.7	57.3	0-100	-
Fatigue		10.12.18	30.98	29.17	27.1	2.8	0-100	-
Nausea and vomiting		14.15	7.79	17.16	78.0	0.5	0-83	-
Pain		9.19	24.31	29.72	46.8	3.7	0-100	-
Dyspnoea		8	21.10	30.59	62.4	4.6	0-100	-
Insomnia		11	27.67	35.25	56.4	9.2	0-100	-
Appetite loss		13	20.48	30.99	63.3	6.4	0-100	-
Constipation		16	27.52	33.97	53.8	1.4	0-100	-
Diarrhea		17	27.67	34.67	53.2	10.6	0-100	-
Financial difficulties		28	51.22	40.61	30.7	30.7	0-100	-

EORTC: European Organization for Research and Treatment of Cancer; QLQ: Quality of Life Questionnaire.

Table 3 Convergent and discriminant validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CR29

QLQ-CR29 scales	Total sample (n = 221)			Patients without stoma (n = 50)			Patients with stoma (n = 171)
	Convergent	Discriminant	α	Convergent	Discriminant	α	Convergent	Discriminant	α
Urinary frequency	0.905-0.907	-0.00-0.25	0.795	0.83-0.84	-0.00-0.21	0.66	0.91-0.92	-0.12-0.25	0.82
Blood or mucus in stool	0.74-0.89	-0.27-0.35	0.615	0.62-0.96	-0.44-0.35	0.581	0.79-0.87	-0.20-0.30	0.65
Body image	-0.66-0.75	-0.00-0.36	0.672	-0.51-0.89	-0.20-0.39	0.690	-0.63-0.72	-0.07-0.19	0.64
Stool frequency	0.83-0.96	-0.30-0.39	0.8351	0.83-0.96	-0.31-0.39	0.804	-0.85-0.91	-0.14-0.34	0.87

¹Mean of cronbach’s alpha coefficient for patients without and with stoma.

Multitrait scaling analysis’ summary of the results; ranges for convergent and discriminant validity of each multiitem scale and their internal consistency using cronbach’s alpha. QLQ: Quality of Life Questionnaire.

Table 4 Correlation between the Quality of Life Questionnaire-CR29 and the Quality of Life Questionnaire-C30

	EORTC QLQ C30
CR-29	Functional scales						Symptom scales
Scales/Single items	QoL	PF	RF	EF	CF	SF	FA	NV	PA	DY	SL	AP	CO	DI	FI
Functional scales
Body image	0.2942	0.2792	0.3702	0.2142	0.2442	0.4032	-0.2982	-0.2562	-0.1611	-0.2502	-0.1511	-0.2782	-0.2212	-0.003	-0.079
Anxiety	0.2972	0.3142	0.2642	0.3152	0.2732	0.2852	-0.2942	-0.1601	-0.2102	-0.1691	-0.1381	-0.117	-0.029	-0.008	-0.1671
Sexual function: Male	-0.121	-0.133	-0.058	-0.011	-0.034	-0.111	0.009	-0.010	0.084	0.089	0.124	0.109	0.049	0.049	0.018
Sexual function: Female	-0.2992	-0.192	-0.115	-0.079	-0.2561	0.040	0.082	-0.033	0.2211	-0.001	0.2301	0.040	0.017	0.112	0.033
Symptom scales
Urinary frequency	-0.1371	-0.2472	-0.2012	-0.2372	-0.089	0.029	0.2442	0.070	0.2182	0.2302	0.1762	0.1651	0.042	0.2212	0.122
Blood and mucus in stool	-0.2412	-0.2832	-0.2692	-0.1902	-0.110	-0.123	0.3592	0.2152	0.3492	0.1902	0.2772	0.2682	0.1521	0.3022	0.2562
Urinary incontinence	-0.009	-0.128	-0.060	-0.2372	-0.1521	-0.050	0.102	0.014	0.108	0.1501	0.1952	0.030	0.1351	0.032	0.044
Dysuria	-0.017	-0.103	-0.1611	-0.069	-0.065	-0.047	0.1531	0.012	0.1721	0.058	0.1331	0.086	0.091	0.100	0.025
Abdominal pain	-0.1381	-0.1611	-0.099	-0.125	-0.099	-0.055	0.2322	0.1431	0.4432	0.1401	0.2542	0.122	0.1681	0.107	-0.039
Buttock pain	-0.2122	-0.2652	-0.2702	-0.103	-0.098	-0.074	0.3632	0.1491	0.4692	0.1942	0.2532	0.1902	0.025	0.1491	0.2802
Bloated feeling	-0.2062	-0.2132	-0.1381	-0.2132	-0.1451	-0.084	0.2922	0.1711	0.3772	0.2562	0.3802	0.058	0.2532	0.040	0.073
Dry mouth	-0.3092	-0.3412	-0.2572	-0.2662	-0.2832	-0.125	0.3402	0.3902	0.2052	0.2022	0.1411	0.3292	0.2112	0.1451	0.113
Hair loss	-0.036	-0.1952	-0.1331	-0.3372	-0.2422	-0.131	0.1832	0.2172	0.084	0.080	0.1411	0.1822	0.2002	0.1351	0.033
Trouble with taste	-0.099	-0.2472	-0.2362	-0.1341	-0.1731	-0.125	0.2432	0.3432	0.036	0.2022	0.010	0.2712	0.1731	0.101	0.072
Weight	0.1762	0.2802	0.2912	0.1571	0.121	0.1792	-0.2382	-0.128	-0.081	-0.060	-0.1431	-0.1651	-0.1691	-0.083	-0.017
Flatulences	0.124	-0.023	0.139	-0.126	-0.180	-0.260	0.077	0.056	-0.062	0.262	0.042	0.065	0.131	0.147	0.117
Leakage	0.083	0.142	0.046	-0.271	-0.128	-0.146	0.033	0.059	-0.023	0.114	-0.004	0.093	0.029	0.127	0.240
Sore skin around stoma	-0.041	-0.190	0.025	-0.6002	-0.4022	-0.3301	0.2951	0.261	0.2971	0.247	0.3802	0.073	0.172	0.002	0.133
Bags changes	-0.085	-0.169	0.002	-0.4042	-0.025	-0.273	0.228	-0.018	0.155	0.218	0.3441	0.192	-0.003	0.019	-0.098
Embarrassment	-0.4072	-0.3122	-0.3942	-0.2721	-0.150	-0.164	0.4762	0.155	0.4192	0.3252	0.3532	0.156	-0.079	0.030	0.3612
Stoma care problems	-0.5022	-0.3912	-0.4582	-0.2771	-0.182	-0.2281	0.5292	0.2391	0.5872	0.3282	0.4682	0.2391	0.093	-0.064	0.3432
Stoma problems	-0.077	-0.142	-0.009	-0.5802	-0.277	-0.3641	0.3361	0.108	0.181	0.264	0.3011	0.138	0.104	0.179	0.139
Flatulences	-0.1601	-0.1511	-0.034	-0.149	-0.137	-0.112	0.144	0.032	0.1771	0.2692	0.1731	-0.003	0.008	0.2522	0.2002
Faecal incontinence	-0.036	-0.081	-0.040	-0.142	-0.122	-0.117	0.1531	0.084	0.1901	0.141	0.111	-0.017	-0.140	0.4032	0.2032
Sore skin around anus	-0.081	-0.012	-0.045	-0.057	-0.047	-0.102	0.049	0.113	0.086	0.121	0.027	0.027	-0.006	0.149	0.1951
Stool frequency	0.002	-0.019	-0.024	-0.071	0.002	0.024	0.083	-0.044	0.2592	0.092	0.123	0.004	-0.035	0.4522	0.1891
Embarrassment	-0.101	-0.133	-0.135	-0.2072	-0.1671	-0.2082	0.1781	0.141	0.149	0.2762	0.1521	0.062	0.146	0.2242	0.2032
Defecation	-0.111	-0.116	-0.038	-0.2021	-0.159	-0.1731	0.1901	0.157	0.2802	0.3162	0.1811	0.040	0.106	0.3792	0.2902
Impotence	0.019	-0.065	-0.149	-0.104	-0.170	-0.2181	0.075	0.2431	-0.104	0.3132	0.065	0.3082	0.175	0.008	0.064
Dyspareunia	-0.083	-0.096	-0.118	-0.174	-0.2431	-0.3452	0.108	0.025	0.2601	0.163	0.162	0.156	0.045	0.157	0.2361

¹P < 0.05.

²P < 0.01.

EORTC: European Organization for Research and Treatment of Cancer; QLQ: Quality of Life Questionnaire; QoL: Quality of life; PF: Physical functioning; RF: Role functioning; EF: Emotional functioning CF: Cognitive functioning; SF: Social functioning; FA: Fatigue; NV: Nausea/vomiting; PA: Pain; DY: Dyspnea; SL: Insomnia; AP: Appetite loss; CO: Constipation; DI: Diarrhea; FI: Financial problems.

Table 5 Known-group comparisons

	Stoma status			Colon vs Rectum			Neoadjuvant radiochemotherapy
CR-29 scales/single items	Yes (n = 50)	No (n = 171)	P value	Colon (n = 78)	Rectum (n = 139)	P value	Yes (n = 89)	No (n = 107)	P value
Urinary frequency	35.6 (41.1)	41.1 (34.6)	0.412	35.4 (31.2)	42.2 (34.8)	0.215	45.5 (33.9)	35.0 (32.2)	0.031
Blood and mucus in stool	27.6 (28.8)	23.8 (29.1)	0.247	20.2 (26.8)	27.4 (30.2)	0.086	29.9 (30.3)	19.3 (27.1)	0.004
Body image	66.6 (27.5)	81.1 (23.0)	0.000	77.4 (24.8)	77.7 (25.0)	0.938	77.6 (24.1)	78.9 (24.5)	0.625
Urinary incontinence	24.0 (35.0)	20.0 (31.4)	0.451	18.3 (28.7)	21.5 (33.0)	0.788	20.2 (32.0)	21.4 (32.1)	0.592
Dysuria	21.3 (29.1)	20.4 (31.9)	0.469	18.8 (30.6)	22.3 (31.9)	0.120	23.2 (32.3)	18.3 (29.7)	0.299
Abdominal pain	28.0 (32.5)	31.3 (34.6)	0.590	28.6 (34.2)	32.1 (34.3)	0.440	34.4 (34.6)	26.7 (33.4)	0.095
Buttock pain	28.6 (33.6)	26.7 (34.9)	0.563	17.0 (30.26	32.3 (36.1)	0.001	38.5 (36.2)	14.3 (27.5)	0.000
Bloated feeling	30.6 (33.5)	28.2 (33.9)	0.545	27.7 (32.4)	29.0 (34.2)	0.892	35.2 (35.6)	23.6 (31.7)	0.017
Dry mouth	30.0 (36.4)	23.0 (33.4)	0.183	20.5 (29.0)	26.6 (36.5)	0.477	30.7 (38.3)	19.0 (28.9)	0.055
Hair loss	17.3 (28.7)	16.1 (29.1)	0.608	10.6 (24.9)	19.4 (31.5)	0.027	18.7 (30.1)	14.6 (28.6)	0.222
Trouble with taste	27.3 (36.0)	18.5 (31.7)	0.069	13.2 (27.5)	24.4 (35.1)	0.016	20.5 (31.1)	17.7 (31.8)	0.375
Anxiety	52.6 (40.4)	67.8 (36.1)	0.016	63.2 (37.8)	65.4 (37.0)	0.658	65.9 (36.5)	63.5 (38.4)	0.725
Weight	69.3 (38.6)	77.3 (30.6)	0.305	79.4 (30.4)	73.8 (33.2)	0.194	75.6 (30.4)	76.3 (33.9)	0.492
Flatulence				45.8 (31.9)	39.3 (32.7)	0.601	35.0 (34.1)	45.6 (33.7)	0.361
Leakage				45.8 (31.9)	40.4 (38.8)	0.558	42.1 (39.8)	45.6 (31.8)	0.705
Sore skin around stoma				39.5 (32.7)	44.4 (41.3)	0.748	50.8 (43.5)	43.8 (33.4)	0.598
Bags changes				21.8 (27.0)	16.6 (20.4)	0.584	17.5 (19.6)	26.3 (27.3)	0.351
Embarrassment				64.5 (28.46)	40.7 (44.9)	0.056	56.3 (46.3)	36.9 (39.8)	0.055
Stoma care problems				37.5 (38.2)	40.7 (42.5)	0.804	54.0 (42.1)	23.4 (36.7)	0.003
Stoma problems				39.9 (17.1)	36.1 (21.6)	0.499	37.1 (23.4)	41.8 (16.4)	0.387
Flatulences				21.5 (33.6)	34.5 (37.3)	0.017	43.8 (39.1)	19.6 (31.8)	0.000
Faecal incontinence				16.12 (30.6)	31.4 (39.5)	0.009	35.7 (41.0)	17.0 (31.5)	0.001
Sore skin around anus				11.8 (24.2)	25.1 (34.6)	0.012	29.5 (36.1)	13.6 (26.0)	0.002
Stool frequency				19.3 (26.8)	35.8 (34.2)	0.002	37.6 (36.1)	21.5 (26.8)	0.008
Embarrassment				23.1 (35.4)	34.9 (39.1)	0.053	40.4 (39.2)	23.4 (35.7)	0.004
Defecation pb				18.8 (21.5)	36.5 (36.5)	0.000	37.8 (27.4)	19.5 (21.0)	0.000
(F) Sexual function: Male	54.1 (39.1)	39.7 (37.1)	0.162	32.4 (32.4)	48.1 (39.4)	0.047	46.3 (39.4)	36.0 (32.8)	0.211
Impotence	47.2 (39.2)	35.6 (38.5)	0.021	31.5 (34.6)	41.6 (40.6)	0.248	43.9 (39.2)	33.3 (36.8)	0.167
Sexual function: Female	56.8 (38.6)	69.6 (36.1)	0.064	65.4 (33.3)	66.6 (39.6)	0.770	69.4 (35.9)	70.0 (35.2)	0.928
Dyspareunia	33.3 (39.1)	24.8 (34.9)	0.156	20.23 (33.1)	29.4 (37.1)	0.240	26.8 (32.6)	23.3 (35.5)	0.459

Table 6 Known-group comparisons, P < 0.0001

	Gender			Age
CR-29 scales/single Items	Male (n = 123)	Female (n = 98)	P value	≤ 40 (n = 26)	41-65 (n = 144)	≥ 66 (n = 45)	P value
Urinary frequency	39.7 (33.1)	40.1 (34.1)	0.862	28.2 (30.4)	42.4 (33.3)	38.1 (34.1)	0.115
Blood and mucus in stool	24.6 (27.8)	24.8 (30.5)	0.794	25.6 (29.5)	26.7 (29.4)	19.2 (27.5)	0.183
Body image	77.4 (25.0)	78.3 (24.7)	0.777	74.3 (23.2)	76.6 (26.1)	80.7 (21.8)	0.481
Urinary incontinence	19.5 (31.9)	22.7 (32.6)	0.385	19.2 (28.5)	19.6 (32.3)	26.6 (33.0)	0.273
Dysuria	23.3 (32.2)	17.3 (29.9)	0.101	23.0 (36.2)	20.8 (31.5)	20.7 (29.5)	0.978
Abdominal pain	27.6 (33.5)	34.3 (34.6)	0.172	32.0 (34.6)	31.9 (35.2)	26.6 (29.8)	0.772
Buttock pain	28.1 (34.9)	25.8 (34.3)	0.478	32.0 (34.6)	27.7 (36.1)	22.2 (30.1)	0.500
Bloated feeling	27.3 (32.8)	30.6 (35.0)	0.495	26.9 (32.6)	31.9 (35.0)	22.9 (30.8)	0.293
Dry mouth	17.3 (28.7)	33.6 (38.1)	0.001	23.0 (33.6)	24.7 (33.8)	25.1 (36.3)	0.967
Hair loss	8.6 (21.7)	26.2 (34.9)	0.000	12.8 (28.4)	19.6 (32.3)	10.3 (19.8)	0.228
Trouble with taste	16.8 (31.4)	25.1 (34.2)	0.040	30.7 (38.7)	20.6 (33.4)	14.8 (27.1)	0.282
Anxiety	69.6 (34.9)	57.8 (39.9)	0.032	65.3 (38.2)	60.1 (38.2)	73.3 (34.5)	0.116
Weight	75.3 (33.3)	75.8 (32.0)	0.920	75.6 (30.6)	74.5 (33.6)	77.0 (31.6)	0.933
Flatulence	43.6 (32.2)	38.3 (34.6)	0.566	38.8 (32.7)	44.7 (33.2)	33.3 (36.5)	0.667
Leakage	47.1 (36.2)	35.0 (36.6)	0.241	61.1 (44.3)	41.9 (34.6)	27.7 (38.9)	0.299
Sore skin around stoma	44.8 (39.1)	40.0 (38.3)	0.650	66.6 (42.1)	42.8 (37.5)	33.3 (36.5)	0.287
Bags changes	20.1 (22.4)	15.8 (23.2)	0.427	22.2 (25.0)	20.9 (23.6)	5.5 (8.6)	0.328
Embarrassment	46.3 (42.4)	44.4 (44.6)	0.680	51.8 (50.3)	51.3 (41.8)	31.4 (40.3)	0.230
Stoma care problems	42.7 (43.1)	36.3 (39.4)	0.481	66.6 (50.0)	40.9 (40.2)	29.6 (37.7)	0.093
Stoma problems	39.8 (20.0)	33.8 (20.3)	0.336	48.1 (31.7)	38.8 (16.9)	23.1 (20.9)	0.183
Flatulences	29.0 (38.5)	32.4 (35.2)	0.452	36.6 (41.7)	33.6 (37.8)	20.5 (31.1)	0.142
Faecal incontinence	23.4 (35.8)	29.4 (39.1)	0.391	40.0 (44.0)	28.7 (38.3)	14.5 (28.4)	0.050
Sore skin around anus	17.3 (29.6)	23.9 (33.9)	0.300	26.6 (36.8)	21.7 (32.8)	12.8 (24.9)	0.266
Stool frequency	27.8 (30.2)	31.8 (34.7)	0.836	35.8 (34.7)	33.0 (33.7)	18.3 (25.0)	0.029
Embarrassment	27.3 (36.5)	35.8 (40.4)	0.179	41.6 (38.8)	36.0 (40.8)	14.5 (26.2)	0.005
Defecation pb	26.9 (25.3)	30.9 (26.4)	0.499	37.5 (33.0)	30.3 (25.5)	17.5 (19.0)	0.032
Sexual function: Male				33.3 (36.9)	42.7 (37.8)	45.8 (36.5)	0.575
Impotence				48.7 (44.3)	35.2 (38.5)	42.0 (35.1)	0.465
Sexual function: Female				57.5 (36.7)	63.5 (37.7)	82.3 (31.4)	0.109
Dyspareunia				33.3 (36.5)	27.6 (36.8)	9.8 (22.8)	0.098