Quality of Life Research

, Volume 16, Issue 10, pp 1635–1645 | Cite as

Spontaneous reports of most distressing concerns in patients with inoperable lung cancer: at present, in retrospect and in comparison with EORTC-QLQ-C30+LC13

  • Eva Broberger
  • Carol Tishelman
  • Louise von Essen
  • Eva Doukkali
  • Mirjam A. G. Sprangers


Patients with lung cancer experience considerable distress. Therefore, accurate methods for assessing distress and quality of life over time may play a key role for managing and evaluating palliative care. Alternatives to commonly used standardized questionnaires are individual measures. This study prospectively and retrospectively explored the concerns that 46 patients with inoperable lung cancer spontaneously reported as causing most distress close to diagnosis and 6 months later. Changes in content individually generated through a structured inductive freelisting were compared with EORTC-QLQ-C30+LC13 ratings. The results showed that patients perceived a wide variety of concerns as most distressing and that their concerns changed over time. Between 56 and 62% of these concerns were assessed by items included in the EORTC-QLQ-C30+LC13 questionnaires. Furthermore, patients’ reports of most distress from fatigue, pain and dyspnea were not always reflected in intensity ratings of comparable EORTC-QLQ-C30+LC13 items. These results indicate that items included in standardized measures are not always adequate to assess patients’ concerns, priorities and changes over time. In addition to standardized questionnaires, individualized measures may be useful in the clinical palliative setting for providing detailed information about the individual’s problems and prioritizations.


Change Distress Freelisting Lung cancer 



Health Care System


Lung cancer


Quality of life



The authors thank the following sources for financial support: The Swedish Cancer Society, The Swedish Heart-Lung Foundation, The Swedish Foundation for Health Care Sciences and Allergy Research, The Research Board for Health Caring Sciences at Karolinska Institutet, and the Department of Neurobiology, Care Sciences and Society at Karolinska Institutet. We also thank Coop Sweden for their support. We would like to express our sincere thanks to Kristina Bertilsson and the other research team colleagues Helena Leveälahti, Ann Rudman and Joakim Öhlén for helpful input and discussions about categorization.


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Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Eva Broberger
    • 1
  • Carol Tishelman
    • 2
    • 3
  • Louise von Essen
    • 5
  • Eva Doukkali
    • 1
  • Mirjam A. G. Sprangers
    • 1
    • 4
  1. 1.Department of Neurobiology, Care Sciences and Society, Division of NursingKarolinska InstitutetStockholmSweden
  2. 2.Research and Development UnitStockholm Sjukhem FoundationStockholmSweden
  3. 3.Department of Learning, Informatics, Management and Ethics, Medical Management CentreKarolinska InstitutetStockholmSweden
  4. 4.Department of Medical Psychology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  5. 5.Department of Public Health and Caring Sciences, Psychosocial oncologyUppsala UniversityUppsalaSweden

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