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Objective: It is well-known that patients with cancer frequently experience sleep problems, and that sleep quality is associated with general quality of life (QoL). The aims of this study were to analyze the relationship between sleep problems and other components of QoL in more detail and to investigate sex and age differences in sleep quality in cancer patients in comparison with the general population., Method: This study comprised one general population sample ( n  = 4,476) and eight samples with cancer patients ( n between 323 and 4,020). Sleep Quality was measured using the QoL questionnaire EORTC QLQ-C30., Results: All of the cancer patient groups reported more sleep problems than the general population. Sleep problems were associated with all facets of QoL both in cancer patients and in the general population. The highest associations were found in cancer patients for fatigue ( r  = 0.52) and emotional functioning ( r  = -0.47). The association between sleep quality and general QoL was lower in the cancer samples ( r  = -0.37) than in the general population ( r  = -0.46). Female cancer patients reported markedly more sleep problems than male patients did ( d  = 0.45), while this sex difference was lower in the general population ( d  = 0.15). In contrast to the general population, younger cancer patients had greater trouble sleeping than older patients did ( d  = -0.17)., Conclusion: The results underline the significance of the role mental factors play in sleep problems. Health care providers should pay special attention to female patients and younger patients concerning this issue., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hofmeister, Schulte, Mehnert-Theuerkauf, Geue, Zenger, Esser, Götze and Hinz.)

Objectives: Quality of life (QoL) has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two., Methods: A sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction (FLZ-M), which measures participants' satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls., Results: Compared with the general population sample, the patients were less satisfied with their health and more satisfied with all other QoL domains. The subjective importance of health was lower in the patients' sample (Effect size: d = 0.38). Satisfaction with health and importance of health were slightly positively correlated ( r between 0.05 and 0.08). The effect of QoL domain importance on general QoL was small (beta between -0.05 and 0.11), and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible., Conclusion: In addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers' attention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hinz, Zenger, Schmalbach, Brähler, Hofmeister and Petrowski.)

Objective: The objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems., Methods: A sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined., Results: The reliability of the ISI was very good (Cronbach's alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15). Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs)., Conclusions: The ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies., (© 2021. The Author(s).)

Background: Sleep problems are frequent in cancer patients. Multiple questionnaires and one-item scales have been developed for measuring sleep quality. The aim of this study was to test the Jenkins Sleep Scale (JSS) in comparison with the one-item sleep scale of the quality of life questionnaire (EORTC QLQ-C30), and to examine the relationship between sleep quality and age, gender, clinical variables, and several domains of quality of life., Methods: A sample of 1216 cancer patients who were treated in an oncological rehabilitation clinic were examined with the JSS, the EORTC QLQ-C30, and several other questionnaires (t1). Participants' sleep quality was then assessed a second time six months later (t2)., Results: The cancer patients reported severe sleep problems, with t1 mean scores of 11.6 (JSS) and 51 (EORTC QLQ-C30 Sleep item). The reliability of the JSS was good (Cronbach's alpha = 0.84). Sleep problems were associated with gender (more problems in females), with several cancer treatment methods, and with all domains of quality of life. The JSS performed only marginally better than the EORTC QLQ-C30 Sleep item in detecting sleep problems., Conclusions: Because of the high prevalence and the strong associations with all quality of life dimensions, sleep problems should be taken into account in cancer care. The one-item sleep instrument of the EORTC QLQ-C30 is sufficient for investigations conducted on a group level., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The most popular body modifications are tattoos and piercings and their prevalence has increased in recent years. The current study gathered statistics regarding tattoing, piercing and body-hair removal, differentiated by gender and attitude towards cosmetic surgery., Methods: The study was based on 2512 individuals and was performed as a population-based survey with the assistance of a demographic consulting company. In addition to sociodemographic questions, specific issues concerning body modification were asked., Results: Men get tattoos more frequently while women more often choose piercings and body hair removal. Women are catching up in the tattoo department and one can no longer observe age differentiations among the younger age groups. Instead there is a decrease in piercings among men. Body hair removal is widespread above all women. People with body modifications tend to be more open-minded about cosmetic surgery., Conclusions: Tattoos and piercings continue to be the most popular body modification among young adults. The number engaged in tattooing is rising while piercings are still popular among women. Individuals being engaged in body modification are prone to consider cosmetic surgery procedures.

Objective: The European Organisation for Research and Treatment of Cancer Quality of Life Group (EORTC QLG) has developed a multidimensional instrument measuring cancer-related fatigue, the EORTC QLQ-FA12. The analysis of sensitivity to change is an essential part of psychometric validation. With this study, we investigated the EORTC QLQ-FA12's sensitivity to change., Methods: The methodology follows the EORTC guidelines of EORTC QLG for phase IV validation of modules. We included cancer patients undergoing curative and palliative treatment at t1 and followed them up prospectively over the course of their treatment (t2) and 4 weeks after completion of treatment (t3). Data were collected prospectively at 17 sites in 11 countries. Sensitivity to change was investigated using analysis of variance., Results: A total sample of 533 patients was enrolled with various tumour types, different stages of cancer, and receiving either curative treatment (n=311) or palliative treatment (n=222). Over time all fatigue scores were significantly higher in the palliative treatment group compared with the curative group (p < .001). Physical fatigue increased with medium effect size over the course of treatment in the curative group (standardized response mean [SRM] (t1,t2) = 0.44]. After treatment physical [SRM (t2,t3) = 0.39], emotional [SRM (t2,t3)= 0.28] and cognitive fatigue (SRM [t2,t3] = 0.22) declined significantly in the curative group. In the palliative group, emotional (SRM [t2,t3] = 0.18) as well as cognitive [SRM [t2,t3] = 0.26) fatigue increases significantly., Conclusions: The EORTC-QLQ-FA12 proved to identify clinically significant changes in fatigue in the course of curative and palliative cancer treatment., (© 2019 John Wiley & Sons, Ltd.)

Background: We validated the new European Organisation for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-HN43)., Methods: We enrolled 812 patients with head and neck cancer from 18 countries. Group 1 completed the questionnaire before therapy, and 3 and 6 months later. In group 2 (survivors), we determined test-retest reliability using intraclass correlation coefficients (ICC). Internal consistency was assessed using Cronbach's Alpha, the scale structure with confirmatory factor analysis, and discriminant validity with known-group comparisons., Results: Cronbach's alpha was >0.70 in 10 of the 12 multi-item scales. All standardized factor loadings exceeded 0.40. The ICC was >0.70 in all but two scales. Differences in scale scores between known-groups were >10 points in 17 of the 19 scales. Sensitivity to change was found to be sufficient in 18 scales., Conclusions: Evidence supports the reliability and validity of the EORTC QLQ-HN43 as a measure of quality of life., (© 2019 Wiley Periodicals, Inc.)

Background: Young adult patients with cancer have to deal with their disease in an eventful phase of life. A common side effect of cancer and its treatment is cancer-related fatigue (CRF), a phenomenon which can thwart successful coping with developmental tasks. The aims of this study were to assess the psychometric properties of the EORTC QLQ-FA12, a new instrument for assessing physical, emotional and cognitive fatigue, in young adults with cancer, and to propose a cut-off value that indicates a need for further more specific diagnostics., Methods: In a sample of young adults who were first diagnosed with cancer between the ages of 18 and 39 years old, we assess the composite and item reliabilities as well as discriminant validity of the subscales for the EORTC QLQ-FA12. We also discuss two possible ways to calculate a summarizing score when conducting a receiver operating characteristic (ROC) analysis to find the cut-off value., Results: The EORTC QLQ-FA12 fit the sample (CFI = 0.96, SRMR = 0.04), had discriminant validity regarding its subscales and every subscale showed convergent validity (composite reliabilities were 0.92 for physical, 0.89 for emotional and 0.74 for cognitive fatigue). The sum of the first ten items with a range of 0 to 30 revealed a cut-off value of twelve or more with 91% sensitivity and 77% specificity., Conclusion: The new instrument EORTC QLQ-FA12 is able to distinguish between physical, emotional, and cognitive fatigue in young adult patients. It enables us to study different concepts of general fatigue without the need for additional items, and can be used as a screening instrument for young adults. Future research should investigate the multidimensional character of CRF.

Purpose: Communication between patients and professionals is one major aspect of the support offered to cancer patients. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) has developed a cancer-specific instrument for the measurement of different issues related to the communication between cancer patients and their health care professionals., Methods: Questionnaire development followed the EORTC QLG Module Development Guidelines. A provisional questionnaire was pre-tested (phase III) in a multicenter study within ten countries from five cultural areas (Northern and South Europe, UK, Poland and Taiwan). Patients from seven subgroups (before, during and after treatment, for localized and advanced disease each, plus palliative patients) were recruited. Structured interviews were conducted. Qualitative and quantitative analyses have been performed., Results: One hundred forty patients were interviewed. Nine items were deleted and one shortened. Patients' comments had a key role in item selection. No item was deleted due to just quantitative criteria. Consistency was observed in patients' answers across cultural areas. The revised version of the module EORTC QLQ-COMU26 has 26 items, organized in 6 scales and 4 individual items., Conclusions: The EORTC COMU26 questionnaire can be used in daily clinical practice and research, in various patient groups from different cultures. The next step will be an international field test with a large heterogeneous group of cancer patients.

Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue., Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries., Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability ≥ 0.60, factor reliability ≥ 0.82) and global model fit (GFI t1|t2 = 0.965/0.957, CFI t1|t2 = 0.976/0.972, RMSEA t1|t2 = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: R t1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90)., Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Background: The objectives of this study were to determine quality of life (QoL) issues that are relevant to thyroid cancer patients cross-culturally, and to identify those with highest relevance to them in addition to the more general issues covered by the core European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30)., Methods: A systematic literature search provided a list of potentially relevant QoL issues to supplement the core questionnaire EORTC QLQ-C30, which is widely used in research and in care and addresses QoL issues relevant to all groups of cancer patients. A panel of experts revised this list, and thyroid cancer patients rated the issues regarding their relevance for QoL by selecting the 25 issues that they would include in a thyroid cancer-specific QoL module., Results: The literature search and expert discussion provided a list of 71 QoL issues that was rated by thyroid cancer patients (n = 110) from seven countries. All issues were of high priority to at least some of the patients. The most frequently selected issues were sudden attacks of tiredness, exhaustion, quality of sleep, employment, social support, fear of cancer progression, fear of second operation, difficulties swallowing, and globus sensation., Conclusions: Thyroid cancer patients cross-culturally rate fatigue-related issues as highly important for their QoL, calling for increased efforts to find successful treatments for this problem. Vocational rehabilitation is also highly relevant for them and should therefore be an important aim of multidisciplinary care. The third important area of concern is psychological issues, especially fear of progression and of additional treatments.

Purpose: This international EORTC validation study (phase IV) is aimed at testing the psychometric properties of a quality of life (QoL) module related to oral health problems in cancer patients., Methods: The phase III module comprised 17 items with four hypothesized multi-item scales and three single items. In phase IV, patients with mixed cancers, in different treatment phases from 10 countries completed the EORTC QLQ-C30, the QLQ-OH module, and a debriefing interview. The hypothesized structure was tested using combinations of classical test theory and item response theory, following EORTC guidelines. Test-retest assessments and responsiveness to change analysis (RCA) were performed after 2 weeks., Results: Five hundred seventy-two patients (median age 60.3, 54 % females) were analyzed. Completion took <10 min for 84 %, 40 % expressed satisfaction that these issues were addressed. Analyses suggested a revision of the phase III hypothesized scale structure. Two items were deleted based on a high degree of item misfit, together with negative patient feedback. The remaining 15 items formed one eight-item scale named OH-QoL score, a two-item information scale, a two-item scale regarding dentures, and three single items (sticky saliva/mouth soreness/sensitivity to food/drink). Face and convergent validity and internal consistency were confirmed. Test-retest reliability (n = 60) was demonstrated as was RCA for patients undergoing chemotherapy (n = 117; p = 0.06). The resulting QLQ-OH15 discriminated between clinically distinct patient groups, e.g., low performance status vs. higher (p < 000.1), and head-and-neck cancer versus other cancers (p < 0.03)., Conclusion: The EORTC module QLQ-OH15 is a short, well-accepted assessment tool focusing on oral problems and QoL to improve clinical management., Trial Registration: ClinicalTrials.gov Identifier: NCT01724333.

Purpose: Medical students have been found to be vulnerable to mental health problems due to the high pressures of medical school. Countries developing into industrial nations tend to adopt Western beauty ideals which might increase eating disorder risk., Methods: This cross-sectional study compared eating (Eating Disorder Inventory 2 EDI-2) and general psychopathology (General Health Questionnaire-28) in medical students from the newly formed German states with a historical sample of East German medical students examined at the time of the German reunification. Current medical students were also compared to population-based samples assessed before the German Reunification as well as recently to consider time trends in EDI scores., Results: The current sample comprised 316 medical students (232 female) from the newly formed German states (mean age = 21.7 years, SD = 2.6). Significantly higher levels of drive for thinness as well as body dissatisfaction and higher levels of general psychopathology were displayed in female medical students 20 years after the German reunification. In male medical students, no significant changes of eating pathology were observable. However, male medical students expressed significantly more anxiety and insomnia and a higher GHQ-28 total score than their counterparts examined in 1989., Conclusions: Twenty years after the Reunification, an acculturation to Western beauty ideals seems to be more pronounced in female than in male medical students. Still, as a group, medical students from the newly formed German states did not appear to display a particular risk to develop eating disorders. However, due to the low response rate, results of this study should be interpreted cautiously.

Purpose: The EORTC QLQ-H&N35 (H&N35) is widely used to measure quality of life in head and neck cancer patients. The aims of this study were to obtain insight into a) the languages in which the H&N35 has been used and the psychometric properties in those languages, b) the study designs, and c) its acceptance by patients and investigators., Methods: A systematic literature review was performed searching for all original papers that had used at least one item of the H&N35. Identified papers were read and the information about methodological issues abstracted statistically analysed., Results: A total of 136 papers were identified. The H&N35 was administered in 19 different languages in 27 countries. The study design was cross-sectional in the majority of studies (53 %), prospective cohort studies (31 %), phase-II-trials (7 %), phase-III-trials (6 %) and case-control studies (1 %). The scales with the highest percentages of missing values were Sexuality (11.5 %) and Speech (7 %). The median Cronbach's alpha of the multi-item scales ranged from 0.61 (Senses) to 0.93 (Sexuality). Construct validity was rarely investigated. On average, 12 scales (range 0-18) of the instrument were used by the investigators. The scale most often used was swallowing (in 85 % of studies) and least often used was Weight Gain (39 %)., Conclusion: The H&N35 is widely used throughout the world, mainly in observational studies, and has demonstrated robust psychometric features in different languages. However, some methodological problems reported imply that the instrument can be improved in some areas.

Background: The objective of this study was to identify relevant quality of life (QOL) issues in patients with head and neck cancer receiving multimodal and/or targeted therapies., Methods: The literature was searched for QOL issues reported after multimodal and/or targeted therapies resulting in a list of potentially relevant issues. These were discussed within a multiprofessional expert group, revised, and subsequently rated for relevance by patients and health care providers., Results: Twenty-seven issues were extracted that are not covered by the current version of the European Organization for Research and Treatment of Cancer (EORTC) questionnaires. Interviews (96 health care providers from 13 countries, 137 patients from 8 countries) revealed that 26 of these issues were relevant for patients with head and neck cancer., Conclusions: Studies investigating targeted and/or multimodal therapy should consider that some QOL issues specific to these treatments are not covered by the current version of the EORTC instruments. Consequently, the EORTC head and neck cancer module is currently in revision., (Copyright © 2012 Wiley Periodicals, Inc.)

The Narcissistic Personality Inventory (NPI) is a commonly used measure of narcissism. This study administered a 15 item short version of the NPI (NPI-15). Central aims of the present study were to examine its dimensionality, and to provide data on its psychometric properties. NPI-15 and Hospital Anxiety and Depression Scale (HADS-D) were assessed in a representative sample of the German population (N=2,512). According to Scree-plot and model fit, a solution with 2 or 3 factors seemed feasible. Because of factor loadings and item-level associations to depression/anxiety we decided to favour a 2-factor-solution. 2 subscales reflecting different facets of narcissism were compiled (leadership ability/personality [LA/LP], grandiosity [G]). The psychometric properties of these scales were good (LA/LP) respectively unsatisfactory (G). The validity of the NPI-15 needs to be further studied., (© Georg Thieme Verlag KG Stuttgart · New York.)

Since many years, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group develops and validates measures for the assessment of quality of life in cancer patients, using high standards of methodology. These questionnaires are meant to be used primarily in clinical trials.As treatment strategies are changing and because of some -methodological criticism, the head and neck module EORTC QLQ-H&N35 is currently being revised and updated.In this paper, we will present the current state of work and other recent developments regarding the EORTC Quality of Life questionnaire development., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: The issue of whether depression increases or decreases with age remains unclear. Methodical aspects play an important role in the research on depression in the elderly., Methods: In a representative survey of the German general population aged 50 years and older (n = 1.156) depressive symptomatology was assessed using the CES-D and the PHQ-2, generalized anxiety (GA) was assessed using the GAD-7., Results: According the CES-D 15.9 % and according to the PHQ-2 9.6 % of the population under study are classified as depressed. Prevalence rates increase with increasing age, but only few age groups show significant differences. The CES-D reveals higher prevalence rates than the PHQ-2. Nevertheless depending on the age group 3.6-7.8 % of the sample exclusively identified by the PHQ-2, and 9.0-14.9 % of the sample are exclusively identified by the CES-D. 4.8 (50-59 yrs.) to 10.3 % (80+ yrs.) report a moderate symptomatology of GA. GA is highly comorbid with depressive symptomatology., Conclusions: The prevalence rates in our study are consistent with previous findings of other studies. Moreover our study underpins the importance of methodical aspects for the prevalence rates identified.