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Psychometric validation of the Breast Cancer Treatment Outcome Scale (BCTOS-12): a prospective cohort study

  • Manuel Feißt
  • Jörg Heil
  • Ilona Stolpner
  • Alexandra von Au
  • Christoph Domschke
  • Christof Sohn
  • Meinhard Kieser
  • Geraldine Rauch
  • André HennigsEmail author
Gynecologic Oncology
  • 25 Downloads

Abstract

Purpose

The Breast Cancer Treatment Outcome Scale (BCTOS) is a questionnaire to evaluate the aesthetic and functional outcome after breast conserving surgery (BCS). The original BCTOS with its 22 items on three subscales was refined to a shorter, improved, and easier to administer patient-reported outcome measure, the BCTOS-12. The BCTOS-12 consists of 12 items on two distinct subscales, the Functional Status and the Aesthetic Status. The aim of this study was to validate the BCTOS-12 in a prospective cohort.

Methods

For this study, 239 breast cancer patients were included preoperatively, and 204 patients completed the BCTOS-12 and EORTC QLQ C30 BR23 shortly after their BCS, corresponding to a follow-up rate of 85%. The item-factor structure was examined by confirmatory factor analysis. The reliability was calculated by McDonald’s Omega for estimating internal consistency. The convergent validity was assessed by Spearman’s rank correlation coefficients between the related scales of the questionnaires.

Results

The BCTOS-12 showed a robust item-factor structure and a good internal consistency with McDonald’s Omega of 0.89 for the Aesthetic Status and 0.90 for the Functional Status. A high convergent and divergent validity was indicated by correlations between the subscales of the EORTC QLQ C30 BR23 and the BCTOS-12.

Conclusion

Overall, the results demonstrate a successful psychometric validation of the BCTOS-12. The BCTOS-12 is a refined, improved, and now validated, instrument. It can be used in clinical studies and routine management for the evaluation of the aesthetic and functional outcome after BCS.

Keywords

Breast Cancer Treatment Outcome Scale BCTOS-12 Breast conserving surgery Aesthetic and functional result Patient-reported outcomes Quality of life 

Notes

Acknowledgements

We would like to thank Michael Hanna, PhD, (Mercury Medical Research & Writing) for proof-reading the manuscript and providing some feedback on the content.

Author contribution

MF: project development, data analysis, manuscript writing. JH: project development, data collection or management, manuscript editing. IS: data collection or management, manuscript editing. AA: data collection or management, manuscript editing. CD: data collection or management, manuscript editing. CS: project development, manuscript editing. MK: project development, manuscript editing. GR: project development, data analysis, manuscript editing. AH: project development, data collection or management, manuscript writing.

Funding

This research received funding from the German Research Foundation (Grant No. RA 2347/3-1 and HE 6824/4-1).

Compliance with ethical standards

Conflict of interest

All authors declare that they have neither a financial nor a non-financial conflict of interest with regard to this paper.

Ethical approval

The study was approved by the Ethics Commission of the Medical School of the University of Heidelberg. All patients gave their written informed consent to participate.

References

  1. 1.
    Hennigs A et al (2016) Prognosis of breast cancer molecular subtypes in routine clinical care: a large prospective cohort study. BMC Cancer 16(1):734CrossRefGoogle Scholar
  2. 2.
    Bray F et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):r394–r424CrossRefGoogle Scholar
  3. 3.
    Montazeri A (2008) Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res 27(1):r1CrossRefGoogle Scholar
  4. 4.
    Nicholson RM, Leinster S, Sassoon EM (2007) A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. The Breast 16(4):r396–r410CrossRefGoogle Scholar
  5. 5.
    Waljee JF et al (2008) Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol 26(20):r3331–r3337CrossRefGoogle Scholar
  6. 6.
    Waljee J et al (2014) Patient expectations and patient-reported outcomes in surgery: a systematic review. Surgery 155(5):r799–r808CrossRefGoogle Scholar
  7. 7.
    Ong WL et al (2017) A standard set of value-based patient-centered outcomes for breast cancer: The International Consortium for Health Outcomes Measurement (ICHOM) Initiative. JAMA Oncol 3(5):r677–r685CrossRefGoogle Scholar
  8. 8.
    Volders JH et al (2017) Cosmetic outcome and quality of life are inextricably linked in breast-conserving therapy. J Surg Oncol 115(8):941–948.  https://doi.org/10.1002/jso.24615 CrossRefPubMedGoogle Scholar
  9. 9.
    Veronesi U et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):r1227–r1232CrossRefGoogle Scholar
  10. 10.
    Fisher B et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):r1233–r1241CrossRefGoogle Scholar
  11. 11.
    Dahlback C, Ringberg A, Manjer J (2019) Aesthetic outcome following breast-conserving surgery assessed by three evaluation modalities in relation to health-related quality of life. Br J Surg 106(1):r90–r99CrossRefGoogle Scholar
  12. 12.
    Erickson VS et al (2001) Arm edema in breast cancer patients. J Natl Cancer Inst 93(2):r96–r111CrossRefGoogle Scholar
  13. 13.
    Krishnan L et al (2001) Form or function? Part 2. Objective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy. Cancer 91(12):r2282–r2287CrossRefGoogle Scholar
  14. 14.
    Madsen AH et al (2008) Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group. Breast 17(2):r138–r147CrossRefGoogle Scholar
  15. 15.
    Nano MT et al (2005) Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 75(11):r940–r947CrossRefGoogle Scholar
  16. 16.
    Sakorafas GH et al (2006) Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol Oxford 15(3):r153–r165CrossRefGoogle Scholar
  17. 17.
    Ojala K, Meretoja TJ, Leidenius MH (2017) Aesthetic and functional outcome after breast conserving surgery - Comparison between conventional and oncoplastic resection. Eur J Surg Oncol 43(4):r658–r664CrossRefGoogle Scholar
  18. 18.
    Wang HT et al (2008) Aesthetic outcomes in breast conservation therapy. Aesthet Surg J 28(2):r165–r170CrossRefGoogle Scholar
  19. 19.
    Jagsi R et al (2015) Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a survey of breast cancer survivors. Ann Surg 261(6):r1198–r1206CrossRefGoogle Scholar
  20. 20.
    Stanton AL, Krishnan L, Collins CA (2001) Form or function? Part 1. Subjective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy. Cancer 91(12):r2273–r2281CrossRefGoogle Scholar
  21. 21.
    Heil J et al (2010) Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS). Breast 19(6):r470–r474CrossRefGoogle Scholar
  22. 22.
    Pukancsik D et al (2017) Objective decision making between conventional and oncoplastic breast-conserving surgery or mastectomy: an aesthetic and functional prospective cohort study. Eur J Surg Oncol 43(2):r303–r310CrossRefGoogle Scholar
  23. 23.
    Hennigs A et al (2018) Development and psychometric validation of a shorter version of the Breast Cancer Treatment Outcome Scale (BCTOS-12). The Breast 38:r58–r65CrossRefGoogle Scholar
  24. 24.
    Sprangers MAG et al (1996) The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol 14(10):r2756–r2768CrossRefGoogle Scholar
  25. 25.
    Aaronson NK et al (1993) The European-Organization-for-Research-and-Treatment-of-Cancer Qlq-C30—a quality-of-life instrument for use in international clinical-trials in oncology. J Natl Cancer Inst 85(5):r365–r376CrossRefGoogle Scholar
  26. 26.
    Waldmann A et al (2007) The OVIS study: health related quality of life measured by the EORTC QLQ-C30 and-BR23 in German female patients with breast cancer from Schleswig-Holstein. Qual Life Res 16(5):r767–r776CrossRefGoogle Scholar
  27. 27.
    Giesinger JM et al (2016) Replication and validation of higher order models demonstrated that a summary score for the EORTC QLQ-C30 is robust. J Clin Epidemiol 69:r79–r88CrossRefGoogle Scholar
  28. 28.
    Reise SP, Morizot J, Hays RD (2007) The role of the bifactor model in resolving dimensionality issues in health outcomes measures. Qual Life Res 16(1):19–31CrossRefGoogle Scholar
  29. 29.
    Moosbrugger H, Schermelleh-Engel K (2012) Exploratorische (EFA) und Konfirmatorische Faktorenanalyse (CFA). Testtheorie und Fragebogenkonstruktion. Springer, Berlin, pp 325–343CrossRefGoogle Scholar
  30. 30.
    Revelle WR (2017) psych: Procedures for personality and psychological researchGoogle Scholar
  31. 31.
    Rosseel Y (2012) Lavaan: an R package for structural equation modeling and more. Version 0.5–12 (BETA). J Stat. Softw 48(2):1–36CrossRefGoogle Scholar
  32. 32.
    Team RC (2018) R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. https://www.R-project.org
  33. 33.
    Irwing P, Booth T, Hughes DJ (2018) The Wiley handbook of psychometric testing: a multidisciplinary reference on survey, scale and test development. Wiley, New YorkCrossRefGoogle Scholar
  34. 34.
    Cohen WA et al (2016) The BREAST-Q in surgical research: a review of the literature 2009–2015. J Plast Reconstr Aesthet Surg 69(2):149–162CrossRefGoogle Scholar
  35. 35.
    O’Connell RL et al (2016) Initial experience of the BREAST-Q breast-conserving therapy module. Breast Cancer Res Treat 160(1):79–89CrossRefGoogle Scholar
  36. 36.
    Weber WP et al (2017) First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat 165(1):139–149CrossRefGoogle Scholar
  37. 37.
    Hennigs A et al (2016) Change of patient-reported aesthetic outcome over time and identification of factors characterizing poor aesthetic outcome after breast-conserving therapy: long-term results of a prospective cohort study. Ann Surg Oncol 23(5):1744–1751CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Gynecology and ObstetricsUniversity of HeidelbergHeidelbergGermany
  3. 3.Institute of Biometry and Clinical EpidemiologyCharité University Hospital BerlinBerlinGermany
  4. 4.Berlin Institute of HealthBerlinGermany

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