FACT-B Most Effective Health-Related Quality of Life Instrument for Breast Cancer

Results from a study evaluating different tools intended to measure patient-reported health-related quality of life (HRQoL) in patients with breast cancer suggest that the Functional Assessment of Cancer Therapy—Breast (FACT-B) may be the most reliable and accurate instrument. 

All forms of cancer are associated with significant adverse side effects that can affect a patient’s overall quality of life. Patient-reported outcomes are one of the most effective ways of measuring the different aspects of a patient’s health and are increasingly being used in health care settings as a primary outcome measure by which different treatments are compared. However, many organizations have created tools capable of assessing a patient’s HRQoL, and little research has been conducted to determine which tool is most accurate and reliable for assessing HRQoL. 
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Thus, researchers, led by Sergio Cedillo, Universidad Carlos III (Madrid, Spain), carried out a systematic literature review of the PubMed and EMBASE databases to evaluate the development or metric properties of different HRQoL instruments for patients with breast cancer. Their results were published in Quality of Life Research

The EMPRO (Evaluating the Measurement of Patient-Reported Outcomes) tool was used to evaluate each patient-reported outcomes instrument identified during the systematic review. Evaluators assessed the different patient-reported instruments by scoring them according to 39 items, organized into eight key attributes: conceptual and measurement model, reliability, validity, responsiveness, interpretability, administration burden, alternative modes of administration, and cross-cultural and linguistic adaptations. 

Eight HRQoL instruments developed by different health care organizations were identified during review and were evaluated by the researchers. The FACT-B scored the highest after EMPRO evaluation, with a cumulative score of 79.27. In addition, FACT-B scored the highest in the conceptual and measurement model (95.24), reliability (83.33), and interoperability (88.89) attributes. 

“According to the EMPRO results of the standardized evaluations, FACT-B is the most recommendable instrument for assessing health-related quality of life in breast cancer patients in general,” researchers concluded. 

However, they noted that other instruments may be better in certain situations; for example, two other instruments, the EROTC BR23 and SF-36, scored higher than FACT-B on the validity attribute.—Sean McGuire


Maratia S, Cedillo S, Rejas J. Assessing health-related quality of life in patients with breast cancer: a systematic and standardized comparison of available instruments using the EMPRO tool. [Published online ahead of print April 5, 2016]. Qual Life Res. doi: 10.1007/s11136-016-1284-8.