International Validation of the EORTC QLQ-ANL27, a Field Study to Test the Anal Cancer-Specific Health-Related Quality of Life Questionnaire

Samantha C Sodergren, Colin D Johnson, Alexandra Gilbert, Anne-Sophie Darlington, Kim Cocks, Marianne G Guren, Eleonor Rivin Del Campo, Christine Brannan, Peter Christensen, William Chu, Hans Chung, Kristopher Dennis, Isacco Desideri, Duncan C Gilbert, Rob Glynne-Jones, Michael Jefford, Mia Johansson, Anders Johnsson, Therese Juul, Dimitrios KardamakisJulia Lai-Kwon, Vicky McFarlane, Isalia M C Miguel, Karen Nugent, Femke Peters, Rachel P Riechelmann, Nazim S Turhal, Shun Wong, Vassilios Vassiliou, European Organisation for Research and Treatment of Cancer Quality of Life Group

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) health-related quality of life questionnaire for anal cancer (QLQ-ANL27) supplements the EORTC cancer generic measure (QLQ-C30) to measure concerns specific to people with anal cancer treated with chemoradiotherapy. This study tested the psychometric properties and acceptability of the QLQ-ANL27.

METHODS AND MATERIALS: People with anal cancer were recruited from 15 countries to complete the QLQ-C30 and QLQ-ANL27 and provide feedback on the QLQ-ANL27. Item responses, scale structure (multitrait scaling, factor analysis), reliability (internal consistency and reproducibility) and sensitivity (known group comparisons and responsiveness to change) of the QLQ-ANL27 were evaluated.

RESULTS: Data from 382 people were included in the analyses. The EORTC QLQ-ANL27 was acceptable, comprehensive, and easy to complete, taking an average 8 minutes to complete. Psychometric analyses supported the EORTC QLQ-ANL27 items and reliability (Cronbach's α ranging from 0.71-0.93 and test-retest coefficients above 0.7) and validity of the scales (particularly nonstoma bowel symptoms and pain/discomfort). Most scales distinguished people according to treatment phase and performance status. Bowel (nonstoma), pain/discomfort, and vaginal symptoms were sensitive to deteriorations over time. The stoma-related scales remained untested because of low numbers of people with a stoma. Revisions to the scoring and question ordering of the sexual items were proposed.

CONCLUSIONS: The QLQ-ANL27 has good psychometric properties and is available in 16 languages for people treated with chemoradiotherapy for anal cancer. It is used in clinical trials and has a potential role in clinical practice.

Original languageEnglish
JournalInternational Journal of Radiation Oncology, Biology, Physics
Pages (from-to)1155-1164
Number of pages10
Publication statusPublished - Apr 2023


  • Anus Neoplasms/radiotherapy
  • Female
  • Humans
  • Psychometrics/methods
  • Quality of Life
  • Reproducibility of Results
  • Surgical Stomas
  • Surveys and Questionnaires


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