International Journal of Colorectal Disease

, Volume 25, Issue 3, pp 369–374 | Cite as

Assessment of body image in patients undergoing surgery for colorectal cancer

  • Robert N. Whistance
  • Rebecca Gilbert
  • Peter Fayers
  • Robert J. Longman
  • Anne Pullyblank
  • Michael Thomas
  • Jane M. Blazeby
Original Article



This study tested the scale properties and validity of the ten-item body image scale (BIS) in patients undergoing surgery for colorectal cancer (CRC).


Patients completed the BIS and a validated measure of health-related quality of life (European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30) after open or laparoscopic resection. A sample of the patients had also previously completed questionnaires before and after surgery. Multi-trait scaling and factor analysis were used to examine the questionnaire scaling, and tests of reliability, clinical and construct validity were performed.


Eighty-two patients (48 male, 59 open, 23 laparoscopic) participated. Scaling analyses suggested a nine-item scale and one single item. This revised scale structure demonstrated good test-retest reliability (r = 0.94) and no overlap with the key domains of the EORTC QLQ-C30 (r < 0.40). Patients with a stoma reported significantly poorer BIS scores than those undergoing simple resection (p = 0.005).


This study provides psychometric and clinical evidence for a revised scale structure for the BIS in CRC, and the questionnaire is suitable to assess body image in CRC clinical trials.


Body image Quality of life Colorectal neoplasms Questionnaires Psychometrics 


  1. 1.
    Parkin DM, Pisani P, Ferlay J (1999) Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80:827–841CrossRefPubMedGoogle Scholar
  2. 2.
    Sargent DJ, Goldberg RM, Jacobson SD, MacDonald JS, Labianca R, Haller DG, Shepherd LE, Seitz JF, Francini G (2001) A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 345:1091–1097CrossRefPubMedGoogle Scholar
  3. 3.
    Cammà C, Giunta M, Fiorica F, Pagliaro L, Craxì A, Cottone M (2000) Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 284(8):1008–1015CrossRefPubMedGoogle Scholar
  4. 4.
    US Food and Drug Administration (2006) Guidance for industry. Patient-reported outcome measures: use in medical product development for labeling claims. US Food and Drug Administration, Rockville, pp 1–32Google Scholar
  5. 5.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ (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 85:365–376CrossRefPubMedGoogle Scholar
  6. 6.
    Sprangers MAG, te Velde A, Aaronson NK (1999) The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). Eur J Cancer 35:238–247CrossRefPubMedGoogle Scholar
  7. 7.
    Gujral S, Conroy T, Fleissner C, Sezer O, King PM, Avery KNL, Sylvester P, Koller M, Sprangers MAG, Blazeby JM (2007) Assessing quality of life in patients with colorectal cancer: an update of the EORTC quality of life questionnaire. Eur J Cancer 29:276–281Google Scholar
  8. 8.
    Cella DF, Tulsky DS, Gray G et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579PubMedGoogle Scholar
  9. 9.
    Ward WL, Hahn EA, Mo F, Hernandex L, Tulsky DS, Cella D (1999) Reliability and validity of the functional assessment of cancer therapy colorectal (FACT-C) quality of life instrument. Qual Life Res 8:181–195CrossRefPubMedGoogle Scholar
  10. 10.
    Hopwood P, Fletcher I, Lee A, Al Ghazal S (2001) A body image scale for use with cancer patients. Eur J Cancer 37:189–197CrossRefPubMedGoogle Scholar
  11. 11.
    Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK (1993) The European organization for research and treatment of cancer approach to quality of life assessment: guidelines for developing questionnaire modules. Qual Life Res 2:287–295CrossRefPubMedGoogle Scholar
  12. 12.
    Tabachnik BJ, Fidel LS (1993) Using multivariate statistics. Harper & Row, LondonGoogle Scholar
  13. 13.
    Fayers PM, Hand DJ (2002) Causal variables, indicator variables and measurement scales. J R Soc Stat Ser A (Stat Soc) 165(2):233–261CrossRefGoogle Scholar
  14. 14.
    Da Silva GM, Hull T, Roberts PL, Ruiz DE, Wexner SD, Weiss EG, Nogueras JJ, Daniel N, Bast J, Hammel J, Sands D (2008) The effect of colorectal cancer surgery in female sexual function, body image, self-esteem and general health: a prospective study. Ann Surg 248(2):266–272CrossRefPubMedGoogle Scholar
  15. 15.
    Cotrim H, Pereira G (2008) Impact of colorectal cancer on patient and family: implications for care. Eur J Oncol Nurs 12:217–226CrossRefPubMedGoogle Scholar
  16. 16.
    Gosselink MP, Busschbach JJ, Dijkhuis CM, Stassen LP, Hop WC, Schouten WR (2006) Quality of life after total mesorectal excision for rectal cancer. Colorectal Dis 8(1):15–22CrossRefPubMedGoogle Scholar
  17. 17.
    Guren MG, Eriksen MT, Wiig JN, Carlsen E, Nesbakken A, Sigurdsson HK, Wibe A, Tveit KM (2005) Norwegian rectal cancer group. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 31(7):735–742CrossRefPubMedGoogle Scholar
  18. 18.
    Conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme ENROL. ISRCTN 48516968 PI R KennedyGoogle Scholar
  19. 19.
    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 199–205Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Robert N. Whistance
    • 1
    • 2
    • 7
  • Rebecca Gilbert
    • 1
  • Peter Fayers
    • 3
    • 4
  • Robert J. Longman
    • 5
  • Anne Pullyblank
    • 6
  • Michael Thomas
    • 5
  • Jane M. Blazeby
    • 1
    • 2
  1. 1.Department of Social MedicineUniversity of BristolBristolUK
  2. 2.Division of Surgery, Head and NeckUniversity Hospital Bristol NHS Foundation TrustBristolUK
  3. 3.Division of Applied Health SciencesUniversity of AberdeenAberdeenUK
  4. 4.Department of Cancer Research and Molecular MedicineNorwegian University of Technology and ScienceTrondheimNorway
  5. 5.Colorectal Unit, Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
  6. 6.Department of General SurgeryNorth Bristol TrustBristolUK
  7. 7.SouthamptonUK

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