Psychometric validation of the Breast Cancer Treatment Outcome Scale (BCTOS-12): a prospective cohort study

  • Manuel Feißt
  • Jörg Heil
  • Ilona Stolpner
  • Alexandra von Au
  • Christoph Domschke
  • Christof Sohn
  • Meinhard Kieser
  • Geraldine Rauch
  • André HennigsEmail author
Gynecologic Oncology



The Breast Cancer Treatment Outcome Scale (BCTOS) is a questionnaire to evaluate the aesthetic and functional outcome after breast conserving surgery (BCS). The original BCTOS with its 22 items on three subscales was refined to a shorter, improved, and easier to administer patient-reported outcome measure, the BCTOS-12. The BCTOS-12 consists of 12 items on two distinct subscales, the Functional Status and the Aesthetic Status. The aim of this study was to validate the BCTOS-12 in a prospective cohort.


For this study, 239 breast cancer patients were included preoperatively, and 204 patients completed the BCTOS-12 and EORTC QLQ C30 BR23 shortly after their BCS, corresponding to a follow-up rate of 85%. The item-factor structure was examined by confirmatory factor analysis. The reliability was calculated by McDonald’s Omega for estimating internal consistency. The convergent validity was assessed by Spearman’s rank correlation coefficients between the related scales of the questionnaires.


The BCTOS-12 showed a robust item-factor structure and a good internal consistency with McDonald’s Omega of 0.89 for the Aesthetic Status and 0.90 for the Functional Status. A high convergent and divergent validity was indicated by correlations between the subscales of the EORTC QLQ C30 BR23 and the BCTOS-12.


Overall, the results demonstrate a successful psychometric validation of the BCTOS-12. The BCTOS-12 is a refined, improved, and now validated, instrument. It can be used in clinical studies and routine management for the evaluation of the aesthetic and functional outcome after BCS.


Breast Cancer Treatment Outcome Scale BCTOS-12 Breast conserving surgery Aesthetic and functional result Patient-reported outcomes Quality of life 



We would like to thank Michael Hanna, PhD, (Mercury Medical Research & Writing) for proof-reading the manuscript and providing some feedback on the content.

Author contribution

MF: project development, data analysis, manuscript writing. JH: project development, data collection or management, manuscript editing. IS: data collection or management, manuscript editing. AA: data collection or management, manuscript editing. CD: data collection or management, manuscript editing. CS: project development, manuscript editing. MK: project development, manuscript editing. GR: project development, data analysis, manuscript editing. AH: project development, data collection or management, manuscript writing.


This research received funding from the German Research Foundation (Grant No. RA 2347/3-1 and HE 6824/4-1).

Compliance with ethical standards

Conflict of interest

All authors declare that they have neither a financial nor a non-financial conflict of interest with regard to this paper.

Ethical approval

The study was approved by the Ethics Commission of the Medical School of the University of Heidelberg. All patients gave their written informed consent to participate.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Gynecology and ObstetricsUniversity of HeidelbergHeidelbergGermany
  3. 3.Institute of Biometry and Clinical EpidemiologyCharité University Hospital BerlinBerlinGermany
  4. 4.Berlin Institute of HealthBerlinGermany

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