Breast Cancer

, 10:204

Measuring quality of life in patients with breast cancer: a systematic review of reliable and valid instruments available in japan

  • Takahiro Okamoto
  • Kojiro Shimozuma
  • Noriyuki Katsumata
  • Michiko Koike
  • Akinori Hisashige
  • Katsuhiro Tanaka
  • Shozo Ohsumi
  • Mitsue Saito
  • Naoto Shikama
  • Michihide Mitsumori
  • Chikako Yamauchi
  • Takanori Watanabe
Original Article



Little is known about the availability and psychometric properties of instruments to measure quality of life (QOL) in clinical research on Japanese patients with breast cancer. The purpose of this systematic review is to find reliable and valid instruments available in Japan, and to summarize their characteristics.


Instruments available in Japan were found through a systematic search of the literature. Each instrument identified was evaluated for item development, reliability, validity, interpretability and utility.


Six questionnaires to measure health-related QOL (the QOL-ACD, the EORTC QLQ-C30, the EORTC QLQ-BR23, the FACT-B, the SF-36, the WHO/QOL-26) and five scales to quantify the psychological burden (the STAI, the POMS, the SDS, the HADS, the GHQ), for which reliability and validity have been documented, are available in Japanese. All instruments were developed in foreign countries except for the QOL-ACD. Two of the QOL questionnaires were specific to breast cancer (the EORTC QLQ-BR23, the FACT-B). Though the measurements can be interpreted in some manner, the meaning of change scores over time has been documented for only three instruments (the EORTC QLQ-C30, the FACT-B, and the GHQ).


The review provides grounds for designing and implementing quantitative research on QOL of breast cancer patients in Japan. Methodological challenges, however, continue, particularly for validating instruments with regard to various study populations of Japanese people and demonstrating the clinical importance of change scores.

Key words

Breast cancer Quality of life (QOL) Instruments Reliability Validity 



Quality of life


the QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs


the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30


the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast 23


the Functional Assessment of Cancer Therapy Breast


the 36-item short form of the Medical Outcomes Study questionnaire


the World Health Organization Quality of Life Assessment questionnaire


the State Trait Anxiety Inventory


the Profile of Mood States


the Self-rating Depression Scale


the Hospital Anxiety and Depression Scale


the General Health Questionnaire

JBCS 1999

the QOL questionnaire for breast conserving therapy proposed by the Japanese Breast Cancer Society in 1999


the Functional Living Index-Cancer


the Quality of Life Index cancer version

Copyright information

© The Japanese Breast Cancer Society 2003

Authors and Affiliations

  • Takahiro Okamoto
    • 1
    • 2
  • Kojiro Shimozuma
    • 3
    • 4
  • Noriyuki Katsumata
    • 5
  • Michiko Koike
    • 6
  • Akinori Hisashige
    • 7
  • Katsuhiro Tanaka
    • 8
  • Shozo Ohsumi
    • 9
  • Mitsue Saito
    • 10
  • Naoto Shikama
    • 11
  • Michihide Mitsumori
    • 12
  • Chikako Yamauchi
    • 12
  • Takanori Watanabe
    • 13
  1. 1.Departments of Endocrine SurgeryJapan
  2. 2.Hygiene and Public Health IITokyo Women’s Medical UniversityJapan
  3. 3.Lnstitute for Scientific Research of StressPublic Health Research FoundationJapan
  4. 4.School of Health Sciences and Nursing, Graduate School of MedicineUniversity of TokyoJapan
  5. 5.Department of Medical OncologyNational Cancer Center HospitalJapan
  6. 6.Cinza Prima ClinicJapan
  7. 7.Department of Preventive MedicineUniversity of Tokushima Graduate School of MedicineJapan
  8. 8.Department of Surgery, Breast and Thyroid DivisionKawasaki Medical SchoolJapan
  9. 9.Department of SurgeryNational Shikoku Cancer CenterJapan
  10. 10.Department of Breast SurgeryNational Cancer Center Research InstituteJapan
  11. 11.Department of RadiologyShinshu University School of MedicineJapan
  12. 12.Department of Therapeutic Radiology and OncologyKyoto University Graduate School of MedicineJapan
  13. 13.Department of Surgery IIFukushima Medical University School of MedicineJapan

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