Quality of Life Research

, Volume 25, Issue 10, pp 2467–2480 | Cite as

Assessing health-related quality of life in patients with breast cancer: a systematic and standardized comparison of available instruments using the EMPRO tool

  • Stefano Maratia
  • Sergio Cedillo
  • Javier Rejas



The objective was to obtain a standardized evaluation of available specific and generic breast cancer health-related quality-of-life instruments.


We carried out systematic literature reviews in the PubMed and EMBASE databases to identify manuscripts which contained information regarding either the development process or metric properties of health-related quality-of-life instruments used among breast cancer patients. Each instrument was evaluated independently by two researchers, and occasionally a third one, using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall score and seven attribute-specific EMPRO scores were calculated (range 0–100, worst to best): concept and measurement model, reliability, validity, responsiveness, interpretability, burden, and alternative forms.


FACT-B was the instrument with the best global performance, obtaining an overall EMPRO score of 79.27. It was also the most accurate instrument on the Concept and Measurement Model, Reliability, and Interpretability attributes. Four more instruments scored over 50 points on the overall score, which summarizes the five attribute-specific scores: EORTC BR-23, IBCSG, WHO-QOL BREF, and SF-36. An overall score of at least 50 points implies that the use of these instruments could be recommended for assessing health-related quality of life in breast cancer patients.


The FACT-B scored the highest on overall on our EMPRO evaluation of instruments measuring health-related quality of life among breast cancer patients. However, depending on the purpose of the study, several instruments (EORTC BR-23, IBCSG, SF-36, and WHO-QOL BREF) have shown good performance in some of the specific individual dimensions included in the EMPRO.


Breast cancer Health-related quality of life Patient-reported outcomes Psychometrics Validation studies EMPRO 


Compliance with ethical standards

Conflict of interest

The work included in the present manuscript has not received any funding, and it is solely the work of the authors. The authors declare that there are no conflict of interests.

Supplementary material

11136_2016_1284_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Stefano Maratia
    • 1
  • Sergio Cedillo
    • 1
    • 2
  • Javier Rejas
    • 3
  1. 1.Universidad Carlos IIIGetafeSpain
  2. 2.TFS PeopleTrial Form Support SpainMadridSpain
  3. 3.Health Economics and Outcomes Research DepartmentPfizer, S.L.U.AlcobendasSpain

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