A Systematic Review of the Measurement Properties of the European Organization for Research and Treatment of Cancer QLQ-BR23 Quality-of-Life Instrument

Background/Aims: The objective of this literature review was to analyze the measurement properties of the European Organization for Research and Treatment of Cancer’s (EORTC) breast cancer-specific quality-of-life questionnaire (QLQ-BR23). Methods: A PubMed search was conducted using the search terms “breast neoplasm,” “quality of life,” and “EORTC” to identify all the articles using the EORTC QLQ-BR23 questionnaire. The search was limited to studies published in the English language from 2005 to 2014. Articles were also searched on HEALTHSTAR and Google Scholar Search and the websites of organizations like the Centers for Disease Control and Prevention, the National Cancer Institute and the EORTC Quality-of-Life group. This study primarily focused on articles looking solely at measurement properties such as discriminative and evaluative properties, reliability, validity and interpretability of the EORTC QLQ-BR23 instrument. Articles that did not report any measure of reliability, such as intraclass correlation coefficient or Cronbach’s alpha, were excluded from the review. Results: Of the 101 articles obtained from the initial search, 18 were relevant and 15 met the inclusion criteria. The QLQ-BR23 instrument had suitable face and content validity. Of those 15 articles that met the inclusion criteria, only 6 established support for convergent-divergent validity. Acceptable convergent-divergent validity was seen in the body image, sexual functioning, systemic therapy side effects, breast symptoms and arm symptoms domains. Construct validity for all domains was supported using the method of known groups in 3 culturally diverse populations when the QLQ-BR23 was used as a discriminating tool. Overall, the instrument exhibited high internal consistency in the diverse populations. Reliability, interpretability and evaluative properties were inadequately studied in the published studies. Discussion: The EORTC QLQ-BR23 instrument is proven to be valid cross-culturally and readily accepted as having high internal consistency. Consequently, it is a suitable instrument for measuring patient-reported outcomes in breast cancer patients. It has good discriminative properties, but evaluative properties need more empirical support. Considerations for future research may include using the QLQ-BR23 module in studies designed to better assess the instrument’s evaluative properties