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Introduction: The quality approach implementation in Moroccan public hospitals (MPH) is a major challenge for improving access, safety, quality, and performance in health care provision. Faced with the increasingly demanding expectations of the health system users and the universal health recommendations, the development of a national health system in accordance with international quality standards is becoming a challenge for the Moroccan health system, hence the importance of implementing a quality approach adapted to each hospital’s context. Design and Methods: This is a cross-sectional study that occurred from January 01, 2018, to March 31, 2021, at the National Institute of oncology (NIO), 12 resource persons participated in the focus group; the documents used included the NIO establishment project, quality activity reports, and the service quality manual. They were chosen using the non-probability sampling method with the conventional technique for resource persons. Results: The results propose a new framework for the implementation of a sustainable and continuous quality approach in MPH. The latter was tested in the NIO and gave convincing results; such as the reduction in infection rates by (30% in 2018 to 04% in 2020), the reduction of the time taken to receive chemotherapy preparations from (between 1 and 2 hours in 2019) to (less than an hour in 2020) and the improvement in group dynamics and communication with users. Conclusion: In this article, we have highlighted the quality governance model, the conceptual framework, the inputs, and the expected results of such an approach. The generalization of this approach in MPH requires another large-scale validation study

Guided by a national cancer plan (2010–19), Morocco made significant investments in improving breast cancer detection and treatment. A breast cancer pattern-of-care study was conducted to document the socio-demographic profiles of patients and tumour characteristics, measure delays in care, and assess the status of dissemination and impact of state-of-the-art management. The retrospective study conducted among 2120 breast cancer patients registered during 2008–17 at the two premier-most oncology centres (Centre Mohammed VI or CM-VI and Institut National d’Oncologie or INO) also measured temporal trends of the different variables. Median age (49 years) and other socio-demographic characteristics of the patients remained constant over time. A significant improvement in coverage of the state-financed health insurance scheme for indigent populations was observed over time. Median interval between onset of symptoms and first medical consultation was 6 months with a significant reduction over time. Information on staging and molecular profile were available for more than 90% and 80% of the patients respectively. Approximately 55% of the patients presented at stage I/II and proportion of triple-negative cancers was 16%; neither showing any appreciable temporal variation. Treatment information was available for more than 90% of the patients; 69% received surgery with chemotherapy and/or radiation. Treatment was tailored to stage and molecular profiles, though breast conservation therapy was offered to less than one-fifth. When compared using the EUSOMA quality indicators for breast cancer management, INO performed better than CM-VI. This was reflected in nearly 25% difference in 5-year disease-free survival for early-stage cancers between the centres., Highlights • Morocco achieved significant progress in quality of breast cancer care in last decade. • Access delay reduced significantly over time but was still high at median 6 months. • More than 80% breast cancer patients had complete molecular profiles. • Many gaps still exist in quality of treatment

Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low-income and middle-income countries. A demonstration project was implemented in Morocco in collaboration with the Ministry of Health to assess the feasibility, acceptability, and challenges of implementing CRC screening through routine primary care facilities.The objective of the project was to screen 10,000 men and women aged 50 to 75 years through 10 primary health centers (PHCs) in 2 provinces. All eligible men and women attending the selected PHCs were offered the fecal immunochemical test (FIT). Stool specimens brought to the PHCs were tested immediately by trained nurses. FIT-positive individuals were referred to the National Oncology Institute for colonoscopy.In total, 9763 eligible men and women were screened by FIT between June 2017 and May 2019; most (73.3%) were women. The test was positive in 460 participants (4.7%). Among the individuals who had positive FIT results, 62.6% underwent colonoscopy. The main reasons for noncompliance to colonoscopy were competing life priorities (15.4%), other health problems (13%), and fear of getting a cancer diagnosis (12.3%). As the number of referrals to colonoscopy increased, the waiting time for the procedure increased, resulting in a drop in compliance. The detection rates of advanced adenomas and CRC were 4.0 in 1000 and 0.5 in 1000 individuals screened, respectively.An effective strategy to reach the target populations (especially men), a pragmatic assessment of the health system's capacity to deal with large numbers of referrals, and a formal cost-effectiveness analysis are essential before making any decision to introduce CRC screening in Morocco.

Introduction. The objective of this study was to investigate the impact of socioeconomic determinants on the quality of life of Moroccan women with breast cancer two years after their diagnosis who are followed up at the National Institute of Oncology (INO) in Rabat. Methods. This is a cross-sectional study that was conducted between May 2019 and September 2020. The sample size was 304 women. Data were collected using the EORTC QLQ-C30 and EORTC QLQ-BR 23 questionnaires in the Moroccan dialect. Results. The mean age of participants was 53.5 ± 12.4 years, where the majority resided in urban areas and more than half were illiterate. Moreover, three-quarters of the survivors were not working, and almost all have basic medical coverage. Nearly one-third of the respondents had experienced discrimination from those around them, and nearly half attributed the decrease in income to their state of health. In addition, 38.2 percent of participants stated that they had great difficulty living on their monthly income after the illness, whereas more than half of the survivors had a good quality of life in terms of overall health (GHS/QOL). Besides, social function obtained the highest score, while emotional function obtained the lowest score. Furthermore, financial difficulty was the most distressing symptom. Indeed, income adjustment after the disease, discrimination, distance between home and treatment center, professional status, and medical coverage were correlated with GHS/QOL. Regression analysis revealed that income adjustment after illness and discrimination were significant predictors of GHS/QOL. Conclusion. The data suggest establishing a financial support program and the development of education and awareness-raising policies to combat discrimination.

Introduction. The aim of this study is to document time intervals in cervical cancer care pathways, from symptom onset to disease detection and start of treatment, and evaluate how clinical, sociodemographic, and treatment factors influence delays throughout a patient’s clinical pathway. Methods. A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in Morocco. Results. 190 medical records of cervical cancer patients were collected. The dominant age group was 35–44, the median patient delay (PD) was 6 days, the median healthcare provider’s delay (HCP) was 21 days, the median referral delay (RD) was 17 days, the median diagnostic delay (DD) was 9.5 days, the median total diagnostic delay (TDD) was 16 days, the median treatment delay (TD) was 67 days, and the median health system interval (HSI) was 92 days. Multivariate analysis revealed that age was associated with the patient delay, the healthcare provider’s delay, the diagnosis delay, and the health system interval. The diagnosis year (the year in which the patient was diagnosed (either before 2012 or during 2012 as well as the other study years (from 2013 to 2017))), all investigations done prior to admission to the oncology hospital, and the age of first sexual activity were significantly associated with healthcare provider’s delay. Conclusion. The integration of a model and standard care pathway into the Moroccan health system is essential in order to unify cervical cancer care in the country.

Examples of successful implementations of national cancer control plans in low-income or middle-income countries remain rare. Morocco, a country where cancer is already the second leading cause of death after cardiovascular diseases, is one exception in this regard. Population ageing and lifestyle changes are the major drivers that are further increasing the cancer burden in the country. Facing this challenge, the Moroccan Ministry of Health has developed a we l planned and pragmatic National Plan for Cancer Prevention and Control (NPCPC) that, since 2010, has been implemented with government financial support to provide basic cancer care services across the entire range of cancer control. Several features of the development and implementation of the NPCPC and health-care financing in Morocco provide exemplars for other low-income and middle-income countries to follow. Additionally, from the first 5 years of NPCPC, several areas were shown to require further focus through implementation research, notably in strengthening cancer awareness, risk reduction, and the referral pathways for prevention, early detection, treatment, and follow-up care. Working together with a wide range of stakeholders, and engagement with stakeholders outside the health-care system on a more holistic approach can provide further opportunities for the national authorities to build on their successes and realise the full potential of present and future cancer control efforts in Morocco.

Depuis la création de la Fondation Lalla Salma le 22 novembre 2005, la lutte contre le cancer au Maroc est devenue une priorité de santé publique. A cet effet, la Fondation et le Ministère de la Santé ont développé le Plan National de Prévention et de Contrôle du Cancer 2010-2019. Dans ce cadre, la Fondation mène des actions dans les domaines de la sensibilisation, de la prévention, de la détection précoce et de l’accès aux soins. De plus, la Fondation développe des activités de solidarité sociale par la construction de "Maisons de vie" pour les patients et leurs proches, la création d’un réseau de bénévoles à travers le Royaume, le développement des soins palliatifs à domicile et le soutien scolaire des orphelins du cancer.Sous le leadership de Son Altesse Royale La Princesse Lalla Salma, La Fondation mobilise les fonds nécessaires, coordonne les différentes actions et fédère les différents intervenants dans la lutte contre le cancer.En tant qu’Ambassadrice de bonne volonté de l'OMS pour la promotion de la prévention et des soins du cancer, Son Altesse Royale a aussi un rôle important dans la plaidoirie pour la lutte contre le cancer dans le monde, et soutient plusieurs pays africains pour la mise en place de programmes de prévention et de contrôle du cancer et d’accès aux médicaments.

In Morocco, most of the cervical cancer patients have been reported diagnosed at advanced stage indicating delay in seeking diagnosis and treatment. The main purpose of this investigation was to measure the delay from the first symptom to treatment among Moroccan women with cervical cancer. Methods: We conducted a cross-sectional study at the National Institute of Oncology Sidi Mohammed Ben Abdellah in Rabat, Morocco. A consecutive series of patients with locally advanced cervical cancer or metastasic [stage II-IV] were recruited. We calculated delay by using two events dates of two periods in patient's pathway. Multivariate binary logistic regression analysis was performed to measure the association between all categories of delay and magnitude of total delay. Results: Four hundred and one patients were reached in this study. The median total delay was 183 days, the median patient delay was 120 days, the median diagnosis delay was 110 days, and the median Treatment delay was 57 days. Bivariate analysis showed that patients who did not have respectively patient and diagnosis delay were less likely to have total delay (p

Depuis la creation de la Fondation Lalla Salma le 22 novembre 2005, la lutte contre le cancer au Maroc est devenue une priorite de sante publique. A cet effet, la Fondation et le Ministere de la Sante ont developpe le Plan National de Prevention et de Controle du Cancer 2010-2019. Dans ce cadre, la Fondation mene des actions dans les domaines de la sensibilisation, de la prevention, de la detection precoce et de l’acces aux soins. De plus, la Fondation developpe des activites de solidarite sociale par la construction de "Maisons de vie" pour les patients et leurs proches, la creation d’un reseau de benevoles a travers le Royaume, le developpement des soins palliatifs a domicile et le soutien scolaire des orphelins du cancer. Sous le leadership de Son Altesse Royale La Princesse Lalla Salma, La Fondation mobilise les fonds necessaires, coordonne les differentes actions et federe les differents intervenants dans la lutte contre le cancer. En tant qu’Ambassadrice de bonne volonte de l'OMS pour la promotion de la prevention et des soins du cancer, Son Altesse Royale a aussi un role important dans la plaidoirie pour la lutte contre le cancer dans le monde, et soutient plusieurs pays africains pour la mise en place de programmes de prevention et de controle du cancer et d’acces aux medicaments.

In Morocco, most Hospital Information System projects undertaken by the Moroccan health sector are technical-oriented and executed as independent projects, with a focus on the management of administrative and financial activities above patient needs and the importance of business process improvement. This paper aims to fill this gap by proposing a global architecture for a Moroccan 'Patient-centered Health Information System' and a method to deploy it. This proposal is based on national and international eHealth experiences and provides a clear and comprehensive view of what a Moroccan Health Information System should look like. This paper focuses on describing the main requirements that should be implemented to enhance the quality of Moroccan patient care.

Background Quality of life has an important place in the future of patients with breast cancer. The objective of this study is to assess the evolution of the patient’s quality of life with breast cancer in Morocco after a year of follow-up. Methods This study involved the patients with breast cancer with all types of treatment as determined by their physicians. Patient’s quality of life was assessed with the Moroccan Arabic version of QLQ- EORTC QLQ C30 and EORTC-BR23 questionnaires. Data were analyzed using SPSS Version 20 software. Results Regarding EOTRC questionnaires QLQ C-30, there was a significant improvement in global health status and all scales of the functional dimension except the social functional where there was a trend towards improvement and the financial impact of the disease where the situation has deteriorated. Quality of life was improved for most symptom-sized scales dimension of EORTC QLQ- C30 with the exception of diarrhea where it was observed degradation. Most of the EORTC QLQ-scales BR23 questionnaires showed a favorable trend in the quality of life except those of sexual functioning, sexual enjoyment, hair loss and the side effects of systemic therapy. Conclusion The quality of life of the patient is significantly improved after 1 year of follow up. Quality of life instruments can be useful in the early identification of patients whose score low on functional scales and symptoms.

Background: Breast cancer is commonly diagnosed at late stages in countries with limited resources. In Morocco, breast cancer is ranked the first female cancer (36.1%) and screening methods could reduce the proportion presenting with a late diagnosis. Morocco is currently adopting a breast cancer screening program based on clinical examination at primary health facilities, diagnosis at secondary level and treatment at tertiary level. So far, there is no systematic information on the performance of the screening program for breast cancer in Morocco. The aim of this study was to analyze early performance indicators. Materials and Methods: A retrospective evaluative study conducted in Temara city. The target population was the entire female population aged between 45-70 years. The study was based on process and performance indicators collected at the individual level from the various health structures in Tamara between 2009 and 2011. Results: A total of 2,350 women participated in the screening program; the participation rate was 35.7%. Of these, 76.8% (1,806) were married and 5.2% (106) of this group had a family history of breast cancer. Of the women who attended screening, 9.3% (190) were found to have an abnormal physical examination findings. A total of 260 (12.7%) were referred for a specialist consultation. The positive predictive value of clinical breast examination versus mammography was 23.0%. Forty four (35.5%) of the lesions found on the mammograms were classified as BI-RADs 3; 4 or 5 category. Cancer was found in 4 (1.95%) of the total number of screened women and benign cases represented 0.58%. Conclusions: These first results of the programme are very encouraging, but there is a need to closely monitor performance and to improve programme procedures with the aim of increasing both the participation rate and the proportion of women eligible to attend screening.

Background: Breast cancer is the most common cancer among women in most countries of the world. It is ranked first in females in Morocco (accounting for 33.4% of the total cancer burden) and more than 60% of cases are diagnosed at stage III or IV. During the last decade, health-related quality of life (HRQOL) has become an important aspect of breast cancer treatment. The objective of this study was to describe self-reported HRQOL in patients with breast cancer and to investigate its associations with sociodemographic and clinical variables. Methods: A prospective study was carried out in the main oncology centers in Morocco. Quality of life was measured using the Moroccan Arabic versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C 30 (EORTC QLQ C30) and the Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). Statistical analyses were performed using descriptive statistics and multivariate analyses. Results: A total of 1463 subjects were included in the study, with a mean age of 55.6 (SD. 11.2) years, 70% being married. The majority had stage II (45.9%) and a few cases stage IV (12.9%) lesions. The participants’ global health mean score was 68.5 and in “functional scales”, social functioning scored the highest (Mean 86.2 (SD=22.7)). The most distressing symptom on the symptom scale was financial difficulties (Mean 63.2 (SD=38.2)). Using the disease specific tool, it was found that future perspective scored the lowest (Mean 40.5 (SD=37.3)). On the symptom scale, arm symptoms scored the highest (Mean 23.6 (SD=21.6)). Significant mean differences were noted for many functional and symptom scales. Conclusion: Our results emphasized that the general HRQOL for our study population is lower than for corresponding populations in other countries. This study provided baseline information on the quality of life for a large sample of Moroccan women diagnosed with breast cancer.

Background A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life. Methods We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up. Results Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21–88). The male–female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. Conclusion Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.

Background Quality of life has become an important concept in cancer care. Among the quality of lifestudies in cancer patients, breast cancer has received most attention. This review reports on quality of life in Arab patients with breast cancer. Methods The search was conducted using inclusion and exclusion criteria and in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases consulted were PubMed, Sciences Direct, Index Medicus for Wordl Health Organization Eastern Mediterranean, African Journals Online and African Index Medicus. Results Thirteen articles from eight countries met the inclusion criteria. The EORTC quality of life questionnaires (QLQ-C30 and QLQ-BR23) were the most used instrument (7 out of 13). The results showed that good scores of global health were recorded at Arab women living in United Arab Emirates (mean score = 74.6) compared to other countries. The results indicated that there was a difference in quality of life scores and its associated factors among Arab women with breast cancer. Conclusion This paper is the first that reviewed published research on quality of life among Arab women with breast cancer. We found that insufficient results-related information is available. Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0468-9) contains supplementary material, which is available to authorized users.

Introduction. This study sought to investigate potential determinants of patient delay among Moroccan women with cervical cancer. Methods. A cross-sectional study was conducted from June 2014 to June 2015 at the National Institute of Oncology in Rabat. Data were collected using questionnaire among patients with cervical cancer locally advanced or metastatic (stages IIA–IVB). Medical records were abstracted to complete clinical information. An interval longer than 90 days between discovery of initial symptoms and presentation to a provider was defined as a patient delay. Results. Four hundred and one patients with cervical cancer enrolled in this study. The mean age was 52.4 years (SD = 11.5). 53.6% were illiterate. Abnormal vaginal bleeding was identified for 65.8% of patients. 60.1% were diagnosed at stages IIA-IIB. 55.4% were found having patient delay. The regression analyses showed the association between literacy (p<0.001), distance of the place of the first consultation (p=0.031), abnormal vaginal bleeding as an earlier symptom (p<0.001), stage at diagnosis (p<0.03), knowledge of symptoms (p<0.001), knowledge of causes (p=0.008), and practice of gynecological exam during the last three years (p=0.018) and the patient delay. Conclusion. Educational messages should aim at increasing awareness of cervical cancer, assisting women in symptom recognition, and encouraging earlier presentation.

Background: Lung cancer is the leading cause of cancer morbidity and mortality. Its management has a significant economic impact on society. Despite a high incidence of cancer, so far, there is no national register for this disease in Morocco. The main goal of this report was to estimate the medical costs of lung cancer in our country. Methods: We first estimated the number of annual new cases according to stage of the disease on the basis of the Grand-Casablanca-Region Cancer Registry data. For each sub-group, the protocol of treatment was described taking into account the international guidelines, and an evaluation of individual costs during the first year following diagnosis was made. Extrapolation of the results to the whole country was used to calculate the total annual cost of treatments for lung cancer in Morocco. Results: Overall approximately 3,500 new cases of lung cancer occur each year in the country. Stages I and II account for only 4% of cases, while 96% are diagnosed at locally advanced or metastatic stages III and IV. The total medical cost of lung cancer in Morocco is estimated to be around USD 12 million. This cost represents approximately 1% of the global budget of the Health Department. According to AROME Guidelines, about 86% of the newly diagnosed lung cancer cases needed palliative treatment while 14% required curative intent therapy. The total cost of early and advanced stages lung cancer management during the first year were estimated to be 4,600 and 3,420 USD, respectively. Conclusion: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco. A substantial proportion of the burden of lung cancer could be prevented through the application of existing cancer control knowledge and by implementing tobacco control programs.

Background: Breast cancer is characterized in Morocco, by the delay in diagnosis, with a high rate of metastatic extension which leads to the difficulty of treatment and an increasement of mortality. It is often the woman who detects breast abnormalities through self-examination. Self-examination alone does not diagnose the breast cancer. Despite it is accessible method in developing countries because it is easy, convenient, private, safe and requires no specific equipment. Aim: The objective was to study the practice of breast self-examination in women in Morocco. Methods: This was a cross-sectional observational study that was conducted in July 2011 based on early detection programs in basic health centers. A total of 1444 women aged from 17 to 86 years were included on the eligibility basis for early detection of breast and cervical cancer in Morocco. For each participant we collected sociodemographic data, information on breast cancer factors, data on the level of knowledge of breast cancer, and information on breast self-examination practice. Results: The average age was 41 years old. The information on breast self-examination came mainly from the media (57, 28%). The practice of the breast self-examination in 56.9%. In our study population, we had 76.6% multiparous, 7.8% nulliparous and 15.6% primiparous. Among the 36 participants, 3% were illiterate, 23% had primary education, 26.4% secondary education and 201 (14%) had a higher education level. The breast self-examination practice was associated with participants´ level of education (OR = 1.69) ( P = 0.000). Membership in the different age groups had no effect on the practice of breast self-examination ( P = 0.182). Conclusion: It is imperative to increase awareness of the practice of breast self-examination and its methods through health education campaigns.

Purpose To estimate the prevalence of sunlight exposure and sun protection behaviors and to identify the main determinants of sun protection in a representative sample of the Moroccan population. Methods Cross-sectional survey was carried out during May 2008 among Moroccan adults aged 18 and over, using stratified cluster sampling in origin and sex. Results A total of 2896 subjects were included. More than half (52.1%) of the participants were regularly exposed to the sun during midday hours (11–16 h) for more than 2 h per day. Among those exposed to the sun during midday hours, 16.4% didn't use any means of protection. The subjects who were more protected were women (odds ratio = 0.47, 95% confidence interval = [0.35–0.64]), rural residents (odds ratio = 2.33, 95% confidence interval = [1.97–2.77]) and worker subjects and students (p Conclusion This survey has highlighted a high prevalence of sun exposure in the Moroccan population with few protection practices. It is therefore important to promote sun protection in order to maintain the incidence rate of skin cancer at its lower level.

Background In Morocco, knowledge of cancer risk factors, a crucial element in the process of behavioral change, has never been evaluated. This study aims to provide information on the level of awareness of cancer risk factors among the Moroccan general population. Methods A cross sectional survey was carried out in May 2008, using a stratified sampling method in a representative sample of the Moroccan adult population. The used questionnaire included social and demographic data as well as questions about 14 cancer related factors regarding passive or active smoking, alcoholic beverages, obesity, physical inactivity, food coloring, red meat, fat, salt, fruit, vegetables, olive oil, green tea, coffee, breast-feeding. Subjects had to choose between 3 propositions for each proposed factor (risk factor/Protective factor/Don’t Know). The knowledge score was calculated by summing the correct answer for each proposed factor except coffee and food coloring. The answer was assigned 1 if it’s correct or 0 if it was incorrect or the participant responded ‘don’t know. The maximum knowledge score was 12. Multivariate linear regression model was used to evaluate the determinants of knowledge score. Results Among 2891 subjects who participated to the survey, 49.5% were men and 42% were from a rural area. The mean age was 41.6 ± 15.2 years. The mean knowledge score of cancer related factors was 8.45 ± 3.10 points. Knowledge score increased with educational level (β = −0.65 if school year ≤6 versus >6) and housing category (β = 1.80 in high standing housing vs rural housing). It was also higher in urban area, among never smokers and among people never consuming alcohol compared to others groups. Conclusion These results provide valuable information necessary to establish relevant cancer prevention strategies in Morocco aiming to enhance and improve people’s knowledge about risk factors especially in some target groups.

Background Quality of life (QOL) and its measurement in cancer patients is becoming increasingly important. Breast cancer diagnosis and treatment are often associated with psychological distress and reduced QoL. In Arabic-speaking countries, QoL of patients with cancer is inadequately studied. The aim of this study was to test the reliability and validity of the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23). Methods After translation and cross-cultural adaptation, the questionnaire was tested on breast cancer patients. The participants’ number for the test and the retest were 105 and 37 respectively. Internal consistency was tested using Cronbach’s alpha coefficient (α), the test-retest reliability using intraclass correlation coefficients (ICC). Construct validity was assessed by examining item-convergent and divergent validity. Results The questionnaire was administered to 105 patients. The mean age of patients was 48 years (SD: 16), 62.9% were married. 68.6% of all participants lived in urban area. The average time to complete the QLQ- BR23 was 15 min. Cronbach’s alpha coefficient, were all >0.7, with the exception of breast symptoms and arm symptoms. All items exceeded the 0.4 criterion for convergent validity except item 20 and 23 related to pain and skin problems in the affected breast respectively. Conclusion In general, the findings of this study indicated that the Moroccan Arabic version of the EORTC QLQ-BR23 is a reliable and valid supplementary measure of the QOL in breast cancer patients and can be used in clinical trials and studies of outcome research in oncology.

Background Understanding the effects of cancer on the quality of life of affected patients is critical to clinical research as well as to optimal management and care. The aim of this study was to adapt the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) questionnaire into Moroccan Arabic and to determine its psychometric properties. After translation, back translation and pretesting of the pre-final version, the translated version was submitted to a committee of professionals composed by oncologists and epidemiologists. The psychometric properties were tested in patients with cancer. Internal consistency was tested using Cronbach’s alpha and the test-retest reliability using interclass correlation coefficients. Construct validity was assessed by examining item-convergent and divergent validity. It was also tested using Spearman’s correlation between QLQ-C30 scales and EQ-5D. Results The study was conducted in 125 patients. The Moroccan version was internally reliable, Cronbach’s α was 0.87 for the total scale and ranged from 0.34 to 0.97 for the subscales. The intraclass correlation coefficient of the test-retest reliability ranged from 0.64 for “social functioning” to 0.89 for “physical activities” subscales. The instrument demonstrated a good construct and concomitant validity. Conclusions We have developed a semantically equivalent translation with cultural adaptation of EORTC QLQ-C30 questionnaire. The assessment of its measurement properties showed that it is quite reliable and a valid measure of the effect of cancer on the quality of life in Moroccan patients.

Background Dietary habits in Morocco are changing and the causes are not well understood. This study aimed to analyse socio-demographic factors associated with adherence to the Mediterranean diet (MeDi) in a national random sample of the adult Moroccan population. Methods The data collected in this cross-sectional survey included socio-demographic factors and a food frequency questionnaire. MeDi adherence was assessed in 2214 individuals with complete dietary data. MeDi adherence was measured according to a simplified MeDi score based on the weekly frequency of intake of eight food groups (vegetables, legumes, fruits, cereal or potatoes, fish, red meat, dairy products and olive oil) with the use of the sex specific medians of the sample as cut-offs. A value of 0 or 1 was assigned to consumption of each component according to its presumed detrimental or beneficial effect on health. Logistic regression was used to estimate the association between MeDi adherence (low score 1-4 vs. high 5-8) and other factors. Results Mean age of the sample was 41.4 (standard deviation 15.3) years, 45.4% were men and 29.9% had a low MeDi adherence. Married subjects (adjusted odds ratio ORa=0.68, 95% CI 0.55-0.84) were less likely to have a low MeDi adherence compared to single, divorced or widowed persons. Persons from rural areas (ORa=1.46, 95% CI: 1.02-2.08), were more often low MeDi adherents compared to those from urban areas. Obese persons (ORa=1.56, 95% CI: 1.16-2.11) were more prone to low MeDi adherence than normal weight individuals. Conclusion MeDi is far from being a universal pattern in the Moroccan population. Intervention strategies should be implemented in target groups to maintain the traditional MeDi pattern considered as the original diet in Morocco.