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Table 2 Comments from patients, the translation coordinator, and EORTC on pilot testing

From: Translation and adaptation of the EORTC QLQ-LC 29 for use in Chinese patients with lung cancer

Item No

Item content

Comments from patients

Changes proposed by the translation coordinator

EORTC comments

Final results

35

Have you been short of breath when you climbed stairs?

One postoperative patient said that healthy people may also feel short of breath when climbing stairs, so the question should be whether the patient feels more shortness of breath compared to the time before treatment or before the illness

Two postoperative patients said they had not climbed stairs in the last week, so they could not answer this question

No changes were required because only one postoperative patient mentioned this issue and two patients did not answer this question

Agreed, no change necessary

No change

39

Have you had hair loss?

One postoperative patient mentioned that healthy people also lose a small amount of hair every day, so the question should be whether the patient is losing more hair than usual due to treatment

We selected another translation from the existing translation column to make it more specific

The translation you selected is for the colorectal patients and the source is slightly different: Have you lost hair as a result of your treatment?

Seeing as 'as a result of your treatment' is not in the source of this questionnaire, I suggest we keep the translation as it is. It should be clear from the context what it is asking, and the comment only comes from one patient

No change

49

Have you been afraid of tumour progression?

One patient undergoing radiotherapy said she did not know her disease was a tumour, so she was a bit confused when she read this question

No changes were required because most patients are aware of their cancer diagnosis nowadays

Agreed, no change necessary

No change

50

Have you had thin or lifeless hair as a result of your disease or treatment?

Three patients undergoing chemotherapy were confused by the chosen Chinese word for “lifeless” ("无生气"); because this word also contains a meaning of “angry” in Chinese

Use another Chinese word (“无生机”) to represent “lifeless” to avoid the ambiguity. Fifty percent of the patients thought the reworded version was better, and the other 50% considered both words were acceptable

For the sake of clarity, you mention that 50% of patients agreed with the change. Did the other 50% disagree and prefer the previous version? Your opinion on whether the change is better would be useful

Replace “无生气" with "无生机"

53

Have you experienced a decrease in your physical capabilities?

One patient undergoing chemotherapy said he did not know how to answer this question because he has not undertaken any physical activity recently

No changes were required because only one patient mentioned this issue

Agreed, no change necessary

No change

54

Has weight loss been a problem for you?

One patient undergoing chemotherapy said he had no weight loss and did not know how to answer this question

Almost all questions in the EORTC QLQ-LC29 are about what symptoms or problems patients have rather than how patients feel about symptoms that they may not have at all. Therefore, we recommend asking patients directly if they have any symptoms or problems, which is consistent with the format of the previous questions

Thank you for your input. I am afraid that we cannot change the wording of the original questionnaire, and the translation must match the source. If patients have not had weight loss, they can select 'not at all'. No change to the translation

No change

56

Has the area of your wound been oversensitive?

One postoperative patient mentioned that the word "oversensitive" was a little difficult to understand

No changes were required because only one postoperative patient mentioned this issue

OK, no change

No change

57

Have you been restricted in your performance due to the extent of surgery?

One postoperative patient mentioned that the meaning of the word “performance” was vague. Does it refer to living ability or daily activities?

“Daily activities” would be more specific than “performance”

If the majority of patients understood, is a change necessary? “Performance” relates to abilities/strength and how well particular tasks can be performed. This is a bit different to 'daily activities'. Seeing as only one patient mentioned this, I suggest no change

No change