Appendix A. Characteristics of generic and breast cancer-specific quality of life
instruments (Instruments are listed alphabetically).
Measure
Purpose
Domains
Scale
1
Beck Depression
Inventory (BDI) [1]
Designed to measure
depression
One domain:
Depression
Inventory
produces a total
score and is
scaled on a four
point Likert
scale
Past two
weeks
21
2
Breast Cancer
Chemotherapy
Questionnaire
(BCQ) [3]
Developed to measure
outcomes of women
with stage II breast
cancer receiving
adjuvant
chemotherapy
Seven domains:
Consequences of hair
loss; emotional
dysfunction; physical
symptoms; trouble and
inconvenience
associated with
treatment; fatigue;
nausea; positive wellbeing
Seven point
Likert scale
ranging in
responses
Past two
weeks
3
Breast Cancer
Prevention Trial
Symptom Checklist
(BCPT) [4, 5]
Designed to examine
the physical and
psychological
symptoms associated
with menopause and
Tamoxifen usage
Eight domains:
Hot flashes; nausea;
bladder control;
vaginal problems;
musculoskeletal pain;
cognitive problems;
weight problems; arm
problems
Five point Likert
scale ranging
from 0 (Not at
all) to 4
(Extremely)
4
Cancer Needs
Questionnaire –
Short Form
(CNQ-SF) [6]
Developed to assess
cancer patients’ needs
Five domains:
Psychological; health
information; physical
and daily living;
patient care and
support; interpersonal
communication
5
Cancer
Rehabilitation
Evaluation System
(CARES-SF) [8]
Developed to assess
patients’ cancerrelated problems
6
Center for
Epidemiologic
Studies Depression
Scale-10
(CES-D)
Designed to measure
depression
1
Reliability
Validity
Selfadministered
(5 minutes)
Reliabilitie
s ranged
from .48 to
.86
Correlation
coefficients
between the
BDI and
clinical ratings
yield
correlations
from .55 to .96
[2]
30
Intervieweradministered
(10-15 minutes)
Internal
consistenc
y ranging
from .89 to
.91
Correlation
coefficients
between BCQ
and Spitzer
QL-Index was
.62
Past four
weeks
43
Self-report
(estimated 30
minutes)
Reliability
was .81
Correlation
coefficients
between BCPT
and SF-36 were
-.40 and -.36
Five point Likert
scale ranging
from 1 (No
need/not
applicable) to 5
(High need for
help)
Unspecified
32
Selfadministered
(estimated 15-20
minutes)
Reliability
ranged
from .77 to
.94
Correlation
coefficients
between CNQSF and EORTC
QLQ-C30 and
BDI ranged
from .23 to .58
[7]
Six domains:
Physical;
psychosocial; medical
interaction; marital;
sexual; global
Five point Likert
scale ranging
from 0 (Not at
all) to 4 (Very
much)
Past month
59
Selfadministered
(average 20
minutes; Range
of 10-34
minutes)
Reliabilitie
s ranged
from .39 to
.82
Correlation
coefficients
between the
CARES-SF
and the
Memorial
Symptom
Assessment
Scale (MSAS)
ranged between
.53 to .73 [9]
One domain:
Depression
Four point Likert
scale ranging
from 0 (Rarely)
to 3 (Most of the
time) and
summed across
the ten items to
provide a total
score.
Past week
10
Selfadministered
(estimated 5
minutes)
Reliability
of .92[10];
Reliability
for CES-D
20 item
scale is .86
[11]
Correctly
identifies 98%
of depressed
patients as
having major
depression [10]
Time frame
No. of
items
Administered
by and
(completion
time)
7
European
Organization for
Research and
Treatment of
Cancer QOL Breast
Cancer Specific
Version
(EORTC QLQBR23) [12]
Designed to measure
QOL in the breast
cancer population at
various stages and
with patients with
differing modalities
Five domains:
Therapy side effects;
arm symptoms; breast
symptoms; body
image; sexual
functioning
Four point Likert
scale ranging
from 1 (Not at
all) to 4 (Very
much)
Past week
23
Self-report
(10 minutes)
Reliabilitie
s ranged
from .70 to
.91
Discriminant
validity of
mutually
exclusive
groups based
on their initial
performance
status scores
produced
medium to
large effect
sizes ranging
from .43 to 1.1
8
European
Organization for
Research and
Treatment of
Cancer QOL
Cancer Specific
Version
(EORTC QLQC30) [13]
Cancer specific
questionnaire
designed to measure
QOL in the cancer
population
Nine domains:
Physical; role,
cognitive; emotional;
social; fatigue; pain;
nausea and vomiting;
global health status
and quality of life
Four point Likert
scale ranging
from 1 (Not at
all) to 4 (Very
much); 1 (Very
poor) to 7
(Excellent)
Past week
30
Selfadministered
(Under 10
minutes)
Reliabilitie
s ranged
from .69 to
.90.[14]
Test-retest
reliabilities
ranged
from .63 to
.87 [15]
Correlation
coefficient
between the
QLQ-C30 and
the Profile of
Mood States
(POMS) was
.56 [16]44].
9
Edmonton
Symptom
Assessment System
(ESAS) [17]
Designed to measure a
variety of symptoms
Nine domains:
Pain; tiredness;
nausea; depression;
anxiety; drowsiness;
appetite; well-being;
shortness of breath
Scaled using a
visual analog
scale
At the time
of
assessment
9
Selfadministered
(estimated 5
minutes)
Internal
consistenc
y
reliability
of .39 to
.86
Correlation
coefficient
between the
ESAS and the
FACT was .85
[18]
10
Functional
Assessment of
Cancer Therapy –
Breast Symptom
Index (FACT-B)
[19]
Specific to breast
cancer patients
Six domains: Physical
well-being;
social/family wellbeing; emotional wellbeing; functional wellbeing; relationship
with doctor; additional
concerns
Five point Likert
scale ranging
from 0 (Not at
all) to 4 (Very
much)
Past week
37
Self-report or
intervieweradministered
(estimated 25
minutes)
Internal
consistenc
y was .90
Spearman
correlations
between FBSI
and FACT
ranged from
.34 to .84
11
Functional
Assessment of
Cancer Therapy –
Endocrine System
(FACT-ES) [20]
Focus on endocrine
concerns experienced
during breast cancer
treatment
One domain:
Endocrine concerns
Five point Likert
scale ranging
from 0 (Not at
all) to 4 (Very
much) and
comprises a total
score
Past week
18
Self-report or
intervieweradministered
(estimated 10
minutes)
Internal
consistenc
y was .79
Test-retest
reliability
was .93
Discriminant
validity of
known groups
comparing
adjuvant
chemotherapy
and those
without any
endocrine
therapy
produced a
significant t
score with the
adjuvant
chemotherapy
group
experiencing
more endocrine
symptoms than
the nonendocrine
therapy group
12
Functional Living
Index – Cancer
(FLIC) [21]
Designed to assess the
effect that cancer
treatment and
symptoms have on
functional ability in all
areas of life
Five domains:
Physical functioning;
mental functioning;
social functioning;
general health/wellbeing; gastrointestinal
symptoms
Seven point
Likert-type
linear analog
scale. Patients
are instructed to
answer the
questions by
placing a vertical
line at the point
Past two
weeks;
Past month;
Today
22
Selfadministered
(Under 10
minutes)
Reliability
ranged
from .64 to
.87.[21]
Correlation
coefficients
between FLIC
and SF-36
ranged from
.50 to .62 [22]
2
in the scale that
best represents
their response
based on various
Likert points
along the scale
13
Geriatric
Depression Scale –
Short Form
(GDS-SF) [23]
Designed to assess
depression in the
elderly
Four domains:
Positive mood; sad
mood; boredom,
memory problems,
and energy level;
staying home
Scaled in a
yes/no format
Past week
15
Selfadministered
(estimated 5
minutes)
Internal
consistenc
y ranged
from .60 to
.77 [24]
Cut off score of
greater than or
equal to 7 in
correctly
diagnosing
depression 79%
of the time [25]
14
Hospital Anxiety
and Depression
Scale
(HADS) [26]
Developed to measure
anxiety and depression
Two domains:
Anxiety and
depression
Four point Likert
scale
Past week
14
Selfadministered
(estimated 5-10
minutes)
Reliabilitie
s of .98 for
total score,
.85 for
anxiety
subscale,
and .80 for
depression
subscale.
Test-retest
reliability
has
produced
coefficient
s over a
two month
period for
the total
score,
anxiety
subscale,
and
depression
subscale
(.79, .79,
and .63
respectivel
y).[27]
Correlation
coefficients
between the
HADS and
Symptom
Checklist 90
scale were .73
(anxiety
subscale) and
.67 (depression
subscale [28]).
15
Life Satisfaction
Questionnaire
(LSQ) [14]
Developed to measure
one’s general sense of
satisfaction with life
as it relates to school,
relationships, leisure
time, religious
practices, and overall
health, specifically for
women with breast
cancer
Six domains:
Quality of family
relation; physical
symptoms;
socioeconomic
situation; quality of
daily activities;
sickness impact; and
quality of close friend
relation
Seven point
Likert scale
ranging from 1
(very much) to 7
(Not at all)
Past week
32
Self-report
(estimated 20
minutes)
Reliabilitie
s ranged
from .62 to
.92
Correlation
coefficients
between LSQ
and EORTC
QLQ-C30 were
-.68 to .54
16
Medical Outcome
Short Form Health
Survey
(SF-36) [29]
Developed to assess
health-related QOL
Eight domains:
Physical functioning;
role limitations due to
physical health; role
limitations due to
emotional problems;
energy/fatigue;
emotional well-being;
social functioning;
bodily pain; general
health
Scaled using
various scales
Unspecified
36
Selfadministered
(5 minutes)
Reliability
ranged
from .74 to
.98 [30]
Correlation
coefficients
between the
SF-36 and the
General health
Questionnaire
(GHQ-29) were
-.35 to =.61
(correlations
are negative
because the
two scales run
in opposite
directions) [31]
3
17
Quality of Life
Index
(QL-Index) [32]
Designed to assess
health outcomes of
those with cancer and
other chronic diseases
Five domains:
Activity; daily living;
health; support;
outlook
Three point
Likert Scale
Past two
weeks
5
Intervieweradministered or
self-administered
(Under 10
minutes)
Internal
consistenc
y of .78
Correlation
coefficients
ranged from
.40 to .63 .[32]
18
Rotterdam
Symptoms
Checklist –
Modified [33]
Developed to assess
symptom-related
distress among cancer
patients
Two domains:
Physical distress and
miscellaneous
variables
Four point Likert
scale ranging
from 1 (Not at
all) to 4 (Very
much)
Past week
28
Selfadministered
(8 minutes)
Reliability
of .88
Correlation
coefficients
ranged from .59 to -.61
when the
Rotterdam
Symptoms
ChecklistModified was
compared with
the SF-36
(correlations
are negative
because the
two scales run
in opposite
directions) [33]
19
Satisfaction with
Life Domains Scale
for Breast Cancer
(SLDS-BC) [34]
Developed to measure
satifaction with life
among breast cancer
patients
Five domains:
Social functioning;
appearance; physical
functioning;
communication with
medical providers;
spirituality
Seven point
Likert-type scale
ranging from 1
(A “delighted”
face) to 7 (A
“very unhappy”
face
Unspecified
32
Self-report
(estimated 20
minutes)
Reliabilitie
s ranged
from .90 to
.93
Correlation
coefficient
between SLDSBC and FACTB was .59
20
World Health
Organization
Quality of Life –
Brief Version
(WHOQOL-BREF)
[35]
Designed to examine
domain level profiles
assessing quality of
life
Four domains:
Physical health;
psychological; social
relationships;
environment
Five point Likert
scale with
varying anchors
Past two
weeks
26
Selfadministered
(estimated 15-20
minutes)
Reliability
ranged
from .66 to
.84.
Similar
alphas
have been
shown for
test-retest
reliability
ranging
from .66 to
.87
Correlation
coefficients
between the
WHOQOLBREF and SF36 ranged from
.36 to .78 [36]
Zung self-rating
depression scale
[37]
Designed to measure
depression
Depression
Four point Likert
scale ranging
from 1 (A little
of the time) to 4
(Most of the
time)
Last 5 days
20
Selfadministered
(estimated 10
minutes)
Internal
consistenc
y of
.58[38]
Scale has
produced good
discriminant
validity as it
was found to be
the primary
discriminating
variable in
distinguishing
depressed from
nondepressed
participants.
[39]
21
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