Female Sexual Function Index (FSFI)

The Female Sexual Function Index (FSFI) is a multidimensional self-report measure of female sexual functioning[REF 1]. It asks women to rate its 19 items according to “the past 4 weeks” using a Likert-type response format. Four of the items are scored from 1 to 5, and fifteen are scored from 0 to 5 (with 0 corresponding to response option “Did not attempt intercourse”). It takes approximately 5-10 minutes to complete.

In additional to the FSFI Total score, the FSFI produces 6 subscale scores corresponding to distinct sexual function domains: Desire (2 items), Arousal (4 items), Lubrication (4 items), Orgasm (3 items), Satisfaction (3 items), and Pain (3 items). The FSFI scoring algorithm sums the items on each subscale and then scales the sums so that each subscale has a maximum possible score of 6. The subscales have a minimum possible score of 0 except for Desire and Satisfaction, which have minimum possible scores of 1.2 and 0.8, respectively. This is because those two subscales contain the four items scored 1 to 5 (instead of 0 to 5). The FSFI total score is the sum of the 6 subscale scores and ranges from 2 to 36. Higher scores indicate better functioning for all scores. Accurate scoring for the FSFI is available in the PROscorer R package using the fsfi() function[REF 2].

The initial FSFI validation study[REF 1] reported excellent internal consistency reliability for the FSFI total score (Cronbach’s α = 0.97) and subscales (Cronbach’s α range = 0.89 to 0.96). A FSFI total score of 26.55 or less has been validated as a diagnostic cut off score suggestive of female sexual dysfunction[REF 3]. The FSFI has also been validated for assessing sexual function among sexually active female cancer survivors[REF 4].

Cognitive Causation (CC) and Negative Affect in Risk (NAR)

The Cognitive Causation (CC) and Negative Affect in Risk (NAR) scales are two new measures of intuitive, gut-level aspects of cancer risk perception[REF 1]. The CC scale measures the extent to which respondents believe that thoughts about cancer risk can encourage the development of the disease, and that minimizing such thoughts can actually reduce cancer risk. It originally contained 10 items[REF 1], but it is recommended to score only 7 items[REF 2]. The NAR scale contains 6 items and measures negative anticipatory affect, or negative emotions (e.g., fear) generated during cancer risk information processing. Both the CC and NAR items have 4, Likert-type response options that are assigned numeric scores: Strongly Disagree = 0, Disagree = 1, Agree = 2, and Strongly Agree = 3. Each instrument takes approximately 2-5 minutes to complete.

The preferred scoring method is to first calculate the mean of the item scores, and then transform that mean to range from 0 to 100. Higher scores indicate greater levels of the constructs being measured[REF 2]. A score should only be assigned to respondents who validly completed at least half of items on a given scale. The CC and NAR scales can be accurately scored using the narcc() function in the PROscorer R package [REF 3].

Both scales have had consistently high reliability across diverse samples, with Cronbach’s alpha coefficients all 0.89 or higher[REF 1]. The items have also demonstrated measurement invariance across highly diverse samples[REF 2].

EORTC QLQ-BLM30

The European Organization for Research and Treatment of Cancer (EORTC) QLQ-BLM30 Muscle-Invasive Bladder Cancer Module is a 30-item questionnaire designed to assess health-related quality of life (HRQoL) in patients with muscle-invasive bladder cancer.[REF 1] The questionnaire asks patients to indicate the extent to which they have experienced each of the problems “during the past week” on a 4-point Likert-type response scale from “Not at all” to “Very much”.

The 30 items of the QLQ-BLM30 yield 7 scale scores. Of the 7 scores, 6 are Symptom Scales and 1 is a Functional Scale. Five of the Symptom Scales are based on multiple items: Urinary Symptoms (7 items), Urostomy Problems (6 items), Future Perspective (3 items), Abdominal Bloating and Flatulence (2 items), and Body Image (3 items). One Symptom Scale is based on a single item (Catheter Use Problems). The single Functional Scale, Sexual Functioning, is based on either 2, 4, 6, or 7 items, depending on whether the respondent is male or female and whether he or she is sexually active. Psychometric validation results for the QLQ-BLM30 are lacking.[REF 1]

The scoring procedure for the QLQ-BLM30 (available at https://qol.eortc.org/questionnaires/) transforms all of the scale and single-item scores to range from 0 to 100. High scores for the functional scale represent high/healthy levels of functioning, but high scores for the symptom scales/items represent high levels of symptomatology/problems. Accurate scoring for the EORTC QLQ-BLM30 is available in the PROscorer R package using the qlq_blm30() function[REF 2]. Note that the QLQ-BLM30 instructs respondents to answer subsets of questions conditional on whether they have a urostomy or not, whether they used a catheter during the past week, whether they are a man or a woman, and whether they have been sexually active during the past 4 weeks. Therefore, not all of the scale scores are applicable to all patients.

EORTC QLQ-C30 (version 3.0)

The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 Quality of Life Questionnaire (version 3.0) is a 30-item questionnaire designed to assess the quality of life of cancer patients[REF 1]. The 30 items of the QLQ-C30 yield both multi-item scale scores and single-item scores, for a total of 16 distinct scores. These include one Global Health Status/QoL scale (2 items), five functional scales (Physical Functioning, 5 items; Role Functioning, 2 items; Emotional Functioning, 4 items; Cognitive Functioning, 2 items; and Social Functioning, 2 items), three symptom scales (Fatigue, 3 items; Nausea and Vomiting, 2 items; and Pain, 2 items), six single item symptom scores (Dyspnea, Insomnia, Appetite Loss, Constipation, Diarrhea, and Financial Difficulties; all from single items), and the more recently validated overall summary score (calculated from the other scores, excluding Global Health Status/QoL and Financial Difficulties)[REF 2]. The questionnaire asks patients to indicate the extent to which they have experienced each of the problems “during the past week” on a 4-point Likert-type scale from “Not at all” to “Very much”. The 2 exceptions are the 2 items of the Global Health Status/QoL scale, which patients are asked to rate on a 7-point scale from “Very poor” to “Excellent”.

The scoring procedure for the QLQ-C30[REF 3] transforms all of the scale and single-item scores to range from 0 to 100. High scores for the Global Health Status/QoL scale represents high QoL, high scores for the functional scales represent high/healthy levels of functioning, but high scores for the symptom scales/items represent high levels of symptomatology/problems. The newer overall summary score also ranges from 0 to 100, with higher scores indicating better functioning and lower levels of symptoms. Accurate scoring for the EORTC QLQ-C30 (version 3.0), including the newer overall summary score, is available in the PROscorer R package using the qlq_c30() function[REF 4]. The QLQ-C30 has been extensively validated and is widely used in clinical trials. The multi-item scales generally have good internal consistency reliability coefficients[REF 1].

EORTC QLQ-CR38

The European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 Colorectal Cancer Module is a 38-item questionnaire designed to assess health-related quality of life (HRQoL) in patients with colorectal cancer.[REF 1] The questionnaire asks patients to indicate the extent to which they have experienced each of the problems “during the past week” on a 4-point Likert-type response scale from “Not at all” to “Very much”.

The 38 items of the QLQ-CR38 yield 12 scale scores. Of the 12 scores, 8 are Symptom Scales and 4 are Functional Scales. Seven of the Symptom Scales are based on multiple items: Micturition Problems (3 items), Gastrointestinal Tract Symptoms (5 items), Chemotherapy Side-Effects (3 items), Problems with Defecation (Only for Pts WITHOUT a stoma) (7 items), Stoma-Related Problems (Only for Pts w/stoma) (7 items), Male Sexual Problems (2 items), and Female Sexual Problems (2 items). There is 1 single-item symptom scale (Weight Loss). Two of the Functional Scales are based on multiple items: Body Image (3 items), and Sexual Functioning (2 items). The other 2 Functional Scales are based on single items (Sexual Enjoyment and Future Perspective).

Note that the QLQ-CR38 instructs respondents to answer subsets of questions conditional on whether they have a have a stoma or not, whether they are a man or a woman, and whether they have been sexually active during the past 4 weeks. Therefore, not all of the scale scores are applicable to all patients.

The scoring procedure for the QLQ-CR38 transforms all of the scale and single-item scores to range from 0 to 100. High scores for the functional scale represent high/healthy levels of functioning, but high scores for the symptom scales/items represent high levels of symptomatology/problems. Accurate scoring for the EORTC QLQ-CR38 is available in the PROscorer R package using the qlq_cr38() function[REF 2]. The scoring instructions for the QLQ-CR38 are no longer available on the EORTC website, and the QLQ-CR38 seems to have been superseded by the QLQ-CR29[REF 3], which was designed in response to concerns that the QLQ-CR38 was outdated and no longer adequately assessed the side effects and possible functional advantages of current treatment regiments for colorectal cancer.

EORTC QLQ-CX24

The European Organization for Research and Treatment of Cancer (EORTC) QLQ-CX24 Cervical Cancer Module is a 24-item questionnaire designed to assess health-related quality of life (HRQoL) in patients with cervical cancer.[REF 1]
The questionnaire asks patients to indicate the extent to which they have experienced each of the problems “during the past week” on a 4-point Likert-type response scale from “Not at all” to “Very much”.

The 24 items of the QLQ-CX24 yield both multi-item scale scores and single-item scores, for a total of 9 distinct scores. Of the 9 scores, 7 are Symptom Scales and 2 are Functional Scales. Three of the Symptom Scales are based on multiple items: Symptom Experience (11 items), Body Image (3 items), and Sexual/Vaginal Functioning (4 items). The other 4 Symptom Scales (Lymphoedema, Peripheral Neuropathy, Menopausal Symptoms, and Sexual Worry) and both Functional Scales (Sexual Activity, Sexual Enjoyment) are all based on single items. In the original psychometric validation study of the QLQ-CX24, internal consistency reliability coefficients for the multi-item scales were 0.72 for Symptom Experience, 0.86 for Body Image, and 0.87 for Sexual/Vaginal Functioning.[REF 1]

The scoring procedure for the QLQ-CX24 (available at https://qol.eortc.org/questionnaires/) transforms all of the scale and single-item scores to range from 0 to 100. High scores for the functional scales represent high/healthy levels of functioning, but high scores for the symptom scales/items represent high levels of symptomatology/problems. Accurate scoring for the EORTC QLQ-CX24 is available in the PROscorer R package using the qlq_cx24() function[REF 2]. Note that the QLQ-CX24 instructs respondents to answer the last 5 questions on the instrument only if they have been sexually active during the past 4 weeks. These 5 items include all 4 items on the Sexual/Vaginal Functioning symptom scale and the 1 item on the Sexual Enjoyment functional scale. These scale scores will be missing for respondents who were not sexually active during the 4 weeks before completing the questionnaire.

EORTC QLQ-PAN26

The European Organization for Research and Treatment of Cancer (EORTC) QLQ-PAN26 Pancreatic Cancer Module is a 26-item questionnaire designed to assess health-related quality of life (HRQoL) in patients with pancreatic cancer. [REF 1] The questionnaire asks patients to indicate the extent to which they have experienced each of the problems “during the past week” on a 4-point Likert-type response scale from “Not at all” to “Very much”. The 26 items of the QLQ-PAN26 yield both multi-item scale scores and single-item scores, for a total of 17 distinct scores. These include two multi-item functional scales (Satisfaction with Health Care, 2 items; Sexuality, 2 items), five multi-item symptom scales (Pancreatic Pain, 4 items; Digestive Symptoms, 2 items; Hepatic Symptoms, 2 items; Altered Bowel Habit, 2 items; Body Image, 2 items;), and 10 single item symptom scales (Bloating, Taste, Indigestion, Flatulence, Weight Loss, Weakness in Arms and Legs, Dry Mouth, Troubled with Side-Effects, Future Worries, and Planning of Activities).[REF 1]. In a large psychometric validation study of the QLQ-PAN26, internal consistency reliability coefficients for the multi-item scales were generally above 0.70 at the pre-surgical baseline assessment as well as at 14- and 60-day post-surgical assessments, with the exception of the Hepatic Symptoms scale which had poor post-surgery reliability.[REF 2]

The scoring procedure for the QLQ-PAN26 (available at https://qol.eortc.org/questionnaires/) transforms all of the scale and single-item scores to range from 0 to 100. High scores for the functional scales represent high/healthy levels of functioning, but high scores for the symptom scales/items represent high levels of symptomatology/problems. Accurate scoring for the EORTC QLQ-PAN26 is available in the PROscorer R package using the qlq_pan26() function[REF 3].

NOTE: At the time this scoring function was written (April 2022), the QLQ-PAN26 had completed Phase 3 testing; however, the official scoring instructions from the EORTC warned that this scaling structure is still preliminary and may change in the future (see https://qol.eortc.org/questionnaires/).