Quality of Life in Adult Cancer Survivors (QLACS)

Abstract

The Quality of Life in Adult Cancer Survivors (QLACS) is a specialized, multidimensional measure designed to assess the quality of life (QoL) specifically in individuals who are long-term cancer survivors (typically defined as five or more years past diagnosis). Developed by Avis et al. (2005), the scale addresses limitations in earlier QoL measures that focused primarily on the acute treatment phase. QLACS consists of 12 distinct subscales, covering both 7 generic QoL domains (e.g., pain, fatigue, social avoidance) and 5 unique cancer-specific domains, such as distress over recurrence and benefits of cancer. The instrument demonstrated strong internal consistency and validity, making it suitable for comparative research between survivor populations and non-cancer populations.

Keywords

Quality of Life, Cancer Survivors, Psychometrics, QLACS, Distress, Fatigue, Cancer-Specific Domains, Long-term follow-up.

Authors

Avis, N. E., Smith, K. W., McGraw, S., Smith, R. G., Petronis, V. M., & Carver, C. S.

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Purpose

The primary purpose of the QLACS scale is to provide a comprehensive assessment of the quality of life (QoL) experienced by individual adult cancer survivors. Unlike measures focused on acute treatment effects, QLACS is specifically tailored to capture the unique, enduring challenges and positive adaptations associated with long-term survivorship, generally five years or more post-diagnosis.

This measure facilitates clinical and research efforts by allowing for detailed tracking of long-term patient outcomes and enabling comparisons between survivor groups and the general population, thereby informing survivorship care guidelines and research.

Construct

The QLACS scale is a multidimensional measure assessing the construct of quality of life within the context of cancer survivorship. It comprises 12 separate domains, which are classified into two major categories: generic QoL and cancer-specific concerns.

The 7 generic QoL domains include: Negative feelings, Positive feelings, Cognitive Problems, Sexual problems (combining interest and function), Physical pain, Fatigue (or energy), and Social Avoidance. The 5 critical cancer-specific domains, developed through extensive qualitative interviews, are: Appearance Concerns, Financial Problems, Distress over Recurrence, Family-Related Distress, and Benefits of Cancer. These domains capture the chronic physical, psychological, social, and existential issues unique to living beyond a cancer diagnosis.

Validity

The QLACS demonstrated good construct and criterion validity. In the initial validation study, correlations between domain scores and external criterion measures were substantial, generally reaching .72 or higher across most of the generic domains. This indicates a strong relationship between the QLACS subscales and established measures of general well-being.

However, correlations were reported as somewhat lower for the cancer-specific domains, suggesting they successfully capture variance unique to the survivorship experience not fully captured by traditional QoL instruments. The scale’s development, which involved in-depth interviews with 59 long-term cancer survivors, ensures strong content validity, reflecting the lived experiences and concerns of this specific population.

Reliability

The internal consistency of the QLACS subscales was rigorously tested during development. Reliability estimates were reported as strong across all domains, using Cronbach’s alpha (Cronbach’s alpha). Specifically, Cronbach’s alpha values were found to be .72 or greater for every single domain subscale. This high level of internal consistency suggests that the items within each domain are highly interrelated and consistently measure the intended underlying construct, providing reliable assessment.

Factor Analysis

The development of the QLACS resulted in a multidimensional factor structure designed to address both general and illness-specific aspects of QoL. The initial item pool was refined and reduced following administration to a large sample of survivors, leading to the identification of 12 distinct subscales. These 12 factors—comprising 7 generic QoL subscales and 5 cancer-specific domains—were empirically derived, supporting the scale’s intended structure as a comprehensive measure of survivorship quality of life.

Instrument

Test Type: Self-report questionnaire, Multidimensional scale

Format: 47 items administered using a 7-point Likert scale (1 = never to 7 = always).

Language Available: English (Other translations may exist but are not specified in the source content).

Population Group: Adult Cancer Survivors

Age Group: Adults (Specifically targeted toward those 5 or more years post-diagnosis).

Population Details: Individuals who have survived cancer and are in the long-term follow-up phase (generally defined as five or more years post-diagnosis). Initial validation samples included 59 individuals for qualitative development and 242 for psychometric analysis.

Test Methodology: Quantitative assessment via self-administered questionnaire measuring the frequency of experiences over the past four weeks.

Keywords

Psychological assessment, Survivorship, Health outcomes, Multidimensional QoL, Physical function, Sexual dysfunction, Distress over recurrence, Cognitive Problems, Fatigue.

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Authors

Author ORCID Identifier: Not specified.

Affiliation Email addresses: Not specified.

Correspondence Address: Not specified.

Permissions & Fee and Test Year

Test Year: 2005 (Year of primary publication).

Permissions and Fees: Information regarding current usage rights and licensing fees is not specified in the source content. Users should contact the primary author, N. E. Avis, or the publisher of Quality of Life Research, for permissions regarding scale use.

Reference’s

Avis, N. E., Smith, K. W., McGraw, S., Smith, R. G., Petronis, V. M., & Carver, C. S. (2005). Assessing quality of life in adult cancer survivors (QLACS). Quality of Life Research, 14, 1007-1023. DOI: 10.1007/s11136-004-5407-7.

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Items of the Quality of Life in Adult Cancer Survivors (QLACS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

• Scales are computed as follows:
• Negative feelings, items 7, 9, 19, and 24
• Positive feelings, items 6, 8, 22, and 28
• Cognitive Problems, items 2, 3, 4, and 23
• Pain, items 13, 17, 21, and 27
• Sexual Interest, items 16 and 26
• Energy/Fatigue, items 1 (reversed), 5, 11, and 14
• Sexual Function, items 10 and 12
• Social Avoidance, items 15, 18, 20, and 25
• Financial Problems, items 30, 37, 43, and 45
• Benefits, items 29, 32, 40, and 41
• Distress-Family, items 31, 34, and 42
• Appearance, items 33, 35, 38, and 44
• Distress-Recurrence, items 36, 39, 46, and 47

INSTRUCTIONS: We’d like to ask you about some things that can affect the quality of people’s lives. Some of these questions may sound similar, but please be sure to answer each one. Below is a scale ranging from “never” to “always”. Please indicate how often each of these statements has been true for you in the past four weeks. [Choose one answer for each question]

• 1 = never
• 2 = seldom
• 3 = sometimes
• 4 = about as often as not
• 5 = frequently
• 6 = very often
• 7 = always

In the past 4 weeks …

1. You had the energy to do the things you wanted to do.
2. You had difficulty doing activities that require concentrating.
3. You were bothered by having a short attention span.
4. You had trouble remembering things.
5. You felt fatigued.
6. You felt happy.
7. You felt blue or depressed.
8. You enjoyed life.
9. You worried about little things.
10. You were bothered by being unable to function sexually.
11. You didn’t have energy to do the things you wanted to do.
12. You were dissatisfied with your sex life.
13. You were bothered by pain that kept you from doing the things you wanted to do.
14. You felt tired a lot.
15. You were reluctant to start new relationships.
16. You lacked interest in sex.
17. Your mood was disrupted by pain or its treatment.
18. You avoided social gatherings.
19. You were bothered by mood swings.
20. You avoided your friends.
21. You had aches or pains.
22. You had a positive outlook on life.
23. You were bothered by forgetting what you started to do.
24. You felt anxious.
25. You were reluctant to meet new people.
26. You avoided sexual activity.
27. Pain or its treatment interfered with your social activities.
28. You were content with your life.

The next set of questions asks specifically about the effects of your cancer or its treatment. Again, for each statement, indicate how often each of these statements has been true for you in the past four weeks.

29. You appreciated life more because of having had cancer.
30. You had financial problems because of the cost of cancer surgery or treatment.
31. You worried that your family members were at risk of getting cancer.
32. You realized that having had cancer helps you cope better with problems now.
33. You were self-conscious about the way you look because of your cancer or its treatment.
34. You worried about whether your family members might have cancer-causing genes.
35. You felt unattractive because of your cancer or its treatment.
36. You worried about dying from cancer.
37. You had problems with insurance because of cancer.
38. You were bothered by hair loss from cancer treatment.
39. You worried about cancer coming back.
40. You felt that cancer helped you to recognize what is important in life.
41. You felt better able to deal with stress because of having had cancer.
42. You worried about whether your family members should have genetic tests for cancer.
43. You had money problems that arose because you had cancer.
44. You felt people treated you differently because of changes to your appearance due to your cancer or its treatment.
45. You had financial problems due to a loss of income as a result of cancer.
46. Whenever you felt a pain, you worried that it might be cancer again.
47. You were preoccupied with concerns about cancer.