Consistency matters: measurement invariance of the EORTC QLQ-C30 questionnaire in patients with hematologic malignancies

  • Kathrin SommerEmail author
  • Francesco Cottone
  • Neil K. Aaronson
  • Peter Fayers
  • Paola Fazi
  • Gianantonio Rosti
  • Emanuele Angelucci
  • Gianluca Gaidano
  • Adriano Venditti
  • Maria Teresa Voso
  • Michele Baccarani
  • Marco Vignetti
  • Fabio Efficace



To ensure that observed differences in the scores of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) reflect actual differences in health-related quality of life (HRQoL) rather than measurement bias, measurement invariance needs to be established. We investigated the assumption of measurement invariance of the EORTC QLQ-C30 in patients with hematological malignancies across age, sex, comorbidity, disease type, and time.


We used a large database of patients with hematological malignancies, which included HRQoL data collected with the EORTC QLQ-C30. We used the structural equation modeling approach to test for measurement (metric and scalar) invariance across groups (age, sex, comorbidity, disease) and time (baseline, 1 month and 2 month follow-up). Longitudinal invariance was examined in a subgroup of patients diagnosed with myelodysplastic syndromes.


Confirmatory factor analyses demonstrated full measurement invariance for age and comorbidity and over time, while support for partial scalar invariance was obtained for sex and disease. Violations of invariance for sex were observed for items of the physical functioning scale and the emotional functioning scale, while for disease type, violations of invariance were observed for items of the physical functioning scale, emotional functioning scale, and the cognitive functioning scale.


Our findings support measurement invariance of the EORTC QLQ-C30 in a large sample of patients with hematological malignancies. The results showed that the number of non-invariant items was negligible, suggesting that this questionnaire is a valid and robust measurement tool in patients with hematological malignancies, also for comparisons across groups and time.


Health-related quality of life EORTC QLQ-C30 Measurement invariance Hematological malignancies Structural equation modeling Confirmatory factor analysis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to this work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kathrin Sommer
    • 1
    Email author
  • Francesco Cottone
    • 1
  • Neil K. Aaronson
    • 2
  • Peter Fayers
    • 3
    • 4
  • Paola Fazi
    • 1
  • Gianantonio Rosti
    • 5
  • Emanuele Angelucci
    • 6
  • Gianluca Gaidano
    • 7
  • Adriano Venditti
    • 8
  • Maria Teresa Voso
    • 8
  • Michele Baccarani
    • 5
  • Marco Vignetti
    • 1
  • Fabio Efficace
    • 1
  1. 1.Data Center and Health Outcomes Research UnitItalian Group for Adult Hematologic Diseases (GIMEMA)RomeItaly
  2. 2.Division of Psychosocial Research and EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Division of Applied Health SciencesUniversity of AberdeenAberdeenUK
  4. 4.European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of MedicineNorwegian University of Science and Technology (NTNU)TrondheimNorway
  5. 5.Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” University HospitalUniversity of BolognaBolognaItaly
  6. 6.Ematologia e Centro TrapiantiIRCCS Ospedale Policlinico San MartinoGenoaItaly
  7. 7.Division of Hematology, Department of Translational MedicineUniversity of Eastern PiedmontNovaraItaly
  8. 8.Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly

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