External validation and updating of prediction models for estimating the 1-year risk of low health-related quality of life in colorectal cancer survivors

Dóra Révész, Sander M.J. van Kuijk, Floortje Mols, Fränzel J.B. van Duijnhoven, Renate M. Winkels, IJmert J. Kant, Piet A. van den Brandt, Luc J. Smits, Stéphanie O. Breukink, Ellen Kampman, Sandra Beijer, Matty P. Weijenberg, Martijn J.L. Bours*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


Objectives: Timely identification of colorectal cancer (CRC) survivors at risk of experiencing low health-related quality of life (HRQoL) in the near future is important for enabling appropriately tailored preventive actions. We previously developed and internally validated risk prediction models to estimate the 1-year risk of low HRQoL in long-term CRC survivors. In this article, we aim to externally validate and update these models in a population of short-term CRC survivors. Study Design and Setting: In a pooled cohort of 1,596 CRC survivors, seven HRQoL domains (global QoL, cognitive/emotional/physical/role/social functioning, and fatigue) were measured prospectively at approximately 5 months postdiagnosis (baseline for prediction) and approximately 1 year later by a validated patient-reported outcome measure (European Organization for Research and Treatment of Cancer Quality of life Questionnaire–Core 30). For each HRQoL domain, 1-year scores were dichotomized into low vs. normal/high HRQoL. Performance of the previously developed multivariable logistic prediction models was evaluated (calibration and discrimination). Models were updated to create a more parsimonious predictor set for all HRQoL domains. Results: Updated models showed good calibration and discrimination (AUC ≥0.75), containing a single set of 15 predictors, including nonmodifiable (age, sex, education, time since diagnosis, chemotherapy, radiotherapy, stoma, and comorbidities) and modifiable predictors (body mass index, physical activity, smoking, anxiety/depression, and baseline fatigue and HRQoL domain scores). Conclusion: Externally validated and updated prediction models performed well for estimating the 1-year risk of low HRQoL in CRC survivors within 6 months postdiagnosis. The impact of implementing the models in oncology practice to improve HRQoL outcomes in CRC survivors needs to be evaluated.

Original languageEnglish
Pages (from-to)127-139
Number of pages13
JournalJournal of Clinical Epidemiology
Publication statusPublished - Dec 2022


  • Cancer survivors
  • Colorectal cancer
  • External validation
  • Fatigue
  • Prediction models
  • Quality of life


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