Authors’ reply to Kar

We thank Dr. Kar for a thorough and insightful analysis of our article on the translation and validation the Quality-of-Life Questionnaire for Anal Cancer (QLQ-ANL27) into Hindi, Marathi, and Bangla.[1,2] This was an initial translation exercise, and validation for clinical use, as well as cultural and linguistic feedback would arise with larger studies, such as the recently conducted Phase IV studies from Western countries.[3] Recognizing the hospital-based context of the study, with such a limited sample size, it's evident that participant demographics, particularly gender and education level, may not align with the demographic data of larger populations. Moreover, the Indian demography does not prominently show gender differences as compared to the West.[4] To address the exclusion of participants with psychiatric illnesses, it is pertinent to acknowledge that this consideration lies beyond the purview of the current validation exercise, but it is a good suggestion for future studies. The foundational paper detailing the development of ANL-27 itself acknowledges this omission, citing that although the psychological impacts of cancer are widely documented in existing literature, they are not unique to anal cancer.[5] Likewise, it is recognized that the ANL-27 module, designed specifically for anal cancer, may not be ideally suited for exploring the spiritual dimensions of cancer. [6] Likewise, it is recognized that the ANL-27 module, designed specifically for anal cancer, may not be ideally suited for exploring the spiritual dimensions of cancer. Alternative instruments such as the European Organization for Research and Treatment of Cancer–Spirituality and Well-being (EORTC-SWB32), explicitly formulated to gauge spiritual well-being, and offer a more tailored approach to evaluate this facet.[4] In conclusion, further research endeavors should aim to address the identified limitations and enhance the comprehensiveness of patient-centered assessments in this population of this rare cancer. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.