Reliability and validity of the modified chinese version of new Cleveland clinic colorectal cancer quality of life questionnaire

Abstract

The New Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) was developed to assess postoperative quality of life (QoL) in patients with colorectal cancer (CRC). Since its introduction, it has been validated in several countries. This study aimed to evaluate the reliability and validity of the Modified Chinese version of the CCF-CaQL and its applicability in the Chinese population. Data analyses were performed using R (version 4.3.3). Questionnaire reliability was assessed using Cronbach’s alpha and composite reliability, with additional reliability evaluated using Spearman’s correlation coefficient and the split-half method. Construct validity was examined using confirmatory factor analysis (CFA), with convergent validity assessed based on factor loadings and discriminant validity evaluated using the heterotrait–monotrait (HTMT) ratio. A total of 215 patients undergoing colorectal cancer surgery were included in this study. The revised questionnaire demonstrated high internal consistency, with a Cronbach’s alpha coefficient of 0.882 and composite reliability (CR) values exceeding 0.70 for all factors. Confirmatory factor analysis showed acceptable convergent validity, with all factors yielding average variance extracted (AVE) values greater than 0.40 and CR values ranging from 0.769 to 0.890. The HTMT coefficients indicated adequate discriminant validity, with most values below the recommended threshold of 0.85 and only one slightly above (0.887). All factors were significantly correlated with the total questionnaire score, with correlation coefficients ranging from 0.508 to 0.855. Furthermore, the questionnaire showed strong correlations with the Chinese versions of the EORTC QLQ-C30 and QLQ-CR29. The modified Chinese version of the CCF-CaQL exhibited strong psychometric properties, confirming its validity and reliability as a disease-specific tool for evaluating quality of life in colorectal cancer patients. This study is the first to translate and validate the CCF-CaQL in Chinese, filling a gap in validated tools for assessing postoperative quality of life in patients with colorectal cancer. The availability of this instrument enables reliable clinical and research applications in Chinese-speaking populations.