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Year : 2020  |  Volume : 16  |  Issue : 1  |  Page : 102-104

Punjabi version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-OES 18 and Quality of Life Questionnaire-OG25 modules for quality of life assessment

1 Department of Radiation Oncology, Max Super Speciality Hospital, Mohali, Punjab, India
2 Department of Medical Oncology, Max Super Speciality Hospital, Mohali, Punjab, India

Date of Submission04-Aug-2017
Date of Acceptance06-Apr-2018
Date of Web Publication26-Oct-2018

Correspondence Address:
Sajal Kakkar
Department of Radiation Oncology, Max Super Speciality Hospital, Phase VI, Near Civil Hospital, Mohali - 160 055, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_683_17

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 > Abstract 

Context: Health-related quality of life (HRQOL) assessment plays an important role in the decision-making process in oncology.
Aims: The aim of the study was to translate European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) OES18 and OG25 in Punjabi language for HRQOL assessment of patients diagnosed with esophagus and esophagogastric malignancies.
Subjects and Methods: The EORTC translation guidelines were duly followed to translate QLQ-OES18 and OG25 into Punjabi language. Each set of questionnaire was independently translated by two forward translators, followed by backward translation of the reconciled version by two independent translators. The final version was submitted to the EORTC Translation Team and served to the patients for the pilot testing.
Results: The questionnaire was administered to ten patients each of esophagus and esophagogastric malignancies who were evaluated and treated at our hospital. Every patient underwent an interview to check if any of the questions was difficult, uncomfortable, or upsetting to answer. Their concerns were recorded as per the template provided by the EORTC team and due changes done if required.
Conclusions: The EORTC QLQ-OES18 and OG25 questionnaire has been translated to Punjabi language and subsequently approved for usage.

Keywords: Esophagus and esophagogastric cancer, OG25, quality of life questionnaire – OES18, translation questionnaire

How to cite this article:
Kakkar S, Arora PK, Goyal G. Punjabi version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-OES 18 and Quality of Life Questionnaire-OG25 modules for quality of life assessment. J Can Res Ther 2020;16:102-4

How to cite this URL:
Kakkar S, Arora PK, Goyal G. Punjabi version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-OES 18 and Quality of Life Questionnaire-OG25 modules for quality of life assessment. J Can Res Ther [serial online] 2020 [cited 2020 Jun 6];16:102-4. Available from: http://www.cancerjournal.net/text.asp?2020/16/1/102/244230

 > Introduction Top

Carcinoma esophagus is the eighth most common cancer worldwide, with an estimated 42,000 new cases being diagnosed every year in Indian population as per International Agency for Research on Cancer Globocan data.[1] The management of noncervical esophageal cancer underwent significant changes since past few years.[2],[3] Preoperative chemoradiation strategies have come to forth as the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study trial[2] showed that preoperative chemoradiation with concurrent carboplatin and paclitaxel significantly improved overall and disease-free survival compared to surgery alone in patients with resectable esophageal or esophagogastric gastroesophageal junction (GEJ) cancers.

As the esophageal cancers form a significant cohort of patients being treated in North India, the Thoracic Oncology group in the hospital planned to prospectively capture the data, especially quality of life (QOL) for the patients undergoing preoperative chemoradiation in esophageal and GE junction (Siewert Type I and II) tumors. In recent times, more and more premium is being paid upon the health-related quality of life (HRQOL) issues, apart from cure and disease control. HRQOL is a multidimensional concept, which covers the subjective assessment of patient's disease-related symptomatology, including physical, emotional, social, and cognitive functions and side effects of treatment as well.[4] Being subjective, measuring HRQOL is quite a challenge.

The most commonly used among the myriad of QOL instruments is European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) modules. While EORTC QLQ-C30 is an important tool for assessing the generic aspect or an overall assessment, EORTC has also developed modules specific to tumor site, treatment modality, or QOL dimension to be administered along with core questionnaire (EORTC QLQ-C30).[5] Among those, QLQ-OES18 (esophageal module) and OG25 (esophagogastric module) have been developed to assess the HRQOL of patients suffering from esophageal and (GEJ) cancers, respectively. These site-specific modules have been validated since in several studies.[6],[7]

The aim of this study is to translate the English version of QLQ-OES 18 and QLQ-OG25 to Punjabi language in coordination with EORTC Translation Team as vast majority of our patients are not well versed with English, hence making it easier to assess HRQOL for the patients speaking Punjabi and diagnosed with esophageal and esophagogastric malignancies.

 > Subjects and Methods Top

After prior approval from EORTC QOL Group, the translation procedures were followed as per the manual, and the English version of QLQ-OES18 and QLQ-OG25 were accessed, translated, and served to the patients of esophageal and esophagogastric (Siewert Type I and II) cancers evaluated and treated (with histopathological confirmation) at Max Super Speciality Hospital, Mohali, Punjab, India, for pilot testing.

European Organization for Research and Treatment of Cancer Quality of Life questionnaire-OES 18

This is a set of 18 questions pertaining to the physical, social, and psychosocial domains for the patients suffering from esophageal malignancy. Each question has four options with a spectrum range from “no problem at all” to “significant problem,” which he/she has to encircle.

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-OG25

This questionnaire has 25 questions related to swallowing, discomfort, pain, psychosocial, and emotional domains with a set of four options each, and the patient has to choose the one applicable to him/her.

Translation procedure

EORTC QOL Group provides a translation manual which gives detailed step-by-step information on how to go through the entire process of translation of questionnaire from English language to the native language.

  1. Forward translation: The first step was to translate the questionnaire (OES18 and OG25) from English to the native language, i.e., Punjabi by two independent translators. These translators had Punjabi as their native language and were fluent in both written and spoken English. The entire team had both medical and nonmedical professionals. The instructions or questions which already had an existing translation in Punjabi and were deemed fine by the translators were copied as such or else re-translated again
  2. Reconciled translation: The next step involved the project manager to compare and analyze the two forward translations now available. A provisional set of questionnaire was developed in consultation with the forward translators
  3. Backward Translation: This provisional questionnaire was served to two independent native English speakers who were fluent in Punjabi too, to translate the set back to English without knowledge of original English version. The project manager then prepared a prefinal set of questionnaire after detailed discussion with the translators. The “difficult words” were modified with the words spoken in colloquial language, but care was taken to preserve the meaning of word or sentence. The interim translation was sent to EORTC QOL team for their comments and advice
  4. Pilot testing: The prefinal questionnaire was administered to ten patients, each of whom were native Punjabi speakers and the demographic profile was captured. Each patient underwent a structured interview as per the template provided by the EORTC Translation Team to ascertain whether any word was difficult to understand, confusing, or offensive. If a patient reported any item/word difficult to comprehend, it was duly recorded, and if any suggestions were made regarding the alternative word, it was incorporated in the response sheet.

 > Results Top

Overall, ten patients each were accrued for the two questionnaires. During forward translation, both the translators had a dilemma to translate the sentence “Have you had” in OES18 and OG25 as well. “Have you had” is seldom used in the colloquial English spoken in our country or specifically this region. After thorough discussion, a consensus was formed and incorporated in the items.

The scale on which the patient decided upon the severity of symptoms ranges from number 1, i.e., “not at all,” to number 4, i.e., “very much” in the ascending order. The preexisting translation of number 3, i.e., “quite a bit,” in EORTC QLQ-OES18 and OG25 was mentioned as “ Bahut Thoda ” in Punjabi which connotes “very less” in English and hence was not fitting properly in the spectrum of the symptom scale. This anomaly was pointed out by several patients in pilot testing and was then translated as “ Thoda jyada ” and sent to EORTC Translation Team for updating with the above reason. The same was incorporated in the final version of the translation.

Q31 in OES18 and OG25 has a word “solid,” for which the forward translators suggested two different words, “ Sakhat ” or “ Thos .” After discussion, Thos word was agreed upon with consensus as it is more commonly used in Punjabi.

Q32 in OES18 and OG25 has a word “liquidized,” and there is no proper word to differentiate between liquid or liquidized in Punjabi. The word “ Taral ” meaning liquid was thus used as a translation for word liquidized too.

Q41 in OES18 and OG25 was not answered by the patients who are on nasogastric tube feeding.

Q45 in OES18 and OG25 says “acid or bile coming into your mouth.” The word “bile” has no literal translation in Punjabi, and to avoid any confusion to the patients, the translation of this word was omitted.

 > Discussion Top

QOL issues pertaining to a specific disease site or a treatment modality plays an important role in deciding the treatment protocol for a given clinical scenario. In the context of clinical trials, QOL assessment provides critical information about the patient's perception to different treatment approaches. Nowadays, patient and the family members put more emphasis on quality of cure being offered and the QOL studies help not only the patients but also the treating clinicians too, to decide the line of management. The OES 18 and OG25 questionnaires have been extensively used and validated in several studies; their translation in Punjabi language was overdue as the disease was being quite common in this part of India. This translation will help the clinicians to get an insight into the subjective assessment by the patients for a given treatment modality and hence to better patient care.

The entire process of translation was completed as per the EORTC translation manual, documented, and submitted to the EORTC. In conclusion, the EORTC QLQ-OES18 and OG25 questionnaires are ready to be used in patients of esophageal and esophagogastric malignancies that have Punjabi as their native language.

 > Conclusion Top

The EORTC quality of life questionnaires OES 18 and OG 25 have been translated in Punjabi language. These modules can be used now to gather essential QOL data in research studies.


The authors would like to thank Bikram Singh, Kulwinder Kaur, Manisha Kakkar, and Paramjeet Kaur for their support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

 > References Top

International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Available from: http://www.globocan.iarc.fr/Pages/facts_sheets. [Last accessed on 2017 Jul 29].  Back to cited text no. 1
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366:2074-84.  Back to cited text no. 2
Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20.  Back to cited text no. 3
Bottomley A. The cancer patient and quality of life. Oncologist 2002;7:120-5.  Back to cited text no. 4
Bottomley A, Aaronson NK; European Organisation for Research and Treatment of Cancer. International perspective on health-related quality-of-life research in cancer clinical trials: The European Organisation for Research and Treatment of Cancer experience. J Clin Oncol 2007;25:5082-6.  Back to cited text no. 5
Blazeby JM, Conroy T, Hammerlid E, Fayers P, Sezer O, Koller M, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer 2003;39:1384-94.  Back to cited text no. 6
Lagergren P, Fayers P, Conroy T, Stein HJ, Sezer O, Hardwick R, et al. Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-OG25, to assess health-related quality of life in patients with cancer of the oesophagus, the oesophago-gastric junction and the stomach. Eur J Cancer 2007;43:2066-73.  Back to cited text no. 7


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