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The development and initial validation of the Breast Cancer Recurrence instrument (BreastCaRe)—a patient-reported outcome measure for detecting symptoms of recurrence after breast cancer

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Abstract

Purpose

Patient-reported outomes (PRO) may facilitate prompt treatment. We describe the development and psychometric properties of the first instrument to monitor for symptoms of breast cancer (BC) recurrence.

Methods

This study is nested in the MyHealth randomized trial of nurse-led follow-up based on electronically-collected PROs. We constructed items assessing symptoms of potential recurrence through expert interviews with six BC specialists in Denmark. Semi-structured cognitive interviews were carried out with a patient panel to assess acceptability and comprehensibility. Items were subsequently tested in a population of 1170 women 1–10 years after completing BC treatment. We carried out multiple-groups confirmatory factor analysis (CFA) and Rasch analysis to test dimensionality, local dependence (LD) and differential item functioning (DIF) according to sociodemographic and treatment-related factors. Clinical data was obtained from the Danish Breast Cancer Group registry.

Results

Twenty-two items were generated for the Breast Cancer Recurrence instrument (BreastCaRe). Cognitive testing resulted in clearer items. Seven subscales based on general, bone, liver, lung, brain, locoregional and contralateral recurrence symptoms were proposed. Both CFA and Rasch models confirmed the factor structure. No DIF was identified. Five item pairs showed LD but all items were retained to avoid loss of clinical information. Rasch models taking LD into account were used to generate a standardized scoring table for each subscale.

Conclusions

The BreastCaRe has good content and structural validity, patient acceptability and measurement invariance. We are preparing to examine the predictive validity of this new instrument.

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Data Availability

The data that support the findings of this study are not publicly available due to data protection legislation.

Code availability

Available upon request.

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Acknowledgements

We wish to thank our expert panel (senior consultants Dr Birgitte Offersen, Dr Michael Andersson, Dr Niels Kroman, and Dr Anders Bonde), our patient panel, and Julie A. Skaarup, who carried out the patient cognitive interviews. We also thank Visti B. Larsen for his invaluable assistance in data management.

Funding

The MyHealth trial was funded by the Danish Cancer Society, Region Zealand, Rigshospitalet (Copenhagen University Hospital) and the Capital Region of Denmark.

Author information

Authors and Affiliations

  1. Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark

    Beverley Lim Høeg, Randi Valbjørn Karlsen, Christoffer Johansen & Pernille Envold Bidstrup

  2. Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark

    Lena Saltbæk & Susanne Oksbjerg Dalton

  3. Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark

    Lena Saltbæk & Susanne Oksbjerg Dalton

  4. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Karl Bang Christensen

  5. Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark

    Christoffer Johansen

  6. Cancer Outcomes Research Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA

    Antonia Bennett

  7. Department of Psychology, University of Copenhagen, Copenhagen, Denmark

    Pernille Envold Bidstrup

Authors
  1. Beverley Lim Høeg
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  2. Lena Saltbæk
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  3. Karl Bang Christensen
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  4. Randi Valbjørn Karlsen
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  6. Susanne Oksbjerg Dalton
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  7. Antonia Bennett
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  8. Pernille Envold Bidstrup
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Contributions

All authors contributed to the study conception and design, data collection, analysis and/or interpretation. All authors contributed to and approved the final manuscript.

Corresponding author

Correspondence to Beverley Lim Høeg.

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Høeg, B.L., Saltbæk, L., Christensen, K.B. et al. The development and initial validation of the Breast Cancer Recurrence instrument (BreastCaRe)—a patient-reported outcome measure for detecting symptoms of recurrence after breast cancer. Qual Life Res 30, 2671–2682 (2021). https://doi.org/10.1007/s11136-021-02841-1

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