Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study (Preprint)

Abstract

BACKGROUND Breast cancer remains the most common neoplasm diagnosed amongst women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate the disease or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research need. Prevalence of individual smartphones and social apps provide a potential electronic approach to administrating questionnaire; however, the reliability of NFBSI-16 in electronic format has not been assessed. OBJECTIVE This study aimed to assess the reliability of web-based measurement of NFBSI-16 in the Chinese language in breast cancer patients undergoing systematic treatment. METHODS We recruited patients with breast cancer under systematic treatment to complete both paper- and web-based questionnaires. Patients were randomly assigned to group A (paper- based first and web-based second) or group B (web- based first and paper-based second). A total of 354 patients included in the analysis successfully completed both versions of the NFBSI-16 questionnaire in Chinese language. Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscale, and total score were analyzed using Wilcoxon test. Lin’s concordance correlation coefficient (CCC), Spearman and Kendall tau rank correlation were used to assess test-retest reliability. RESULTS Test-retest reliability was excellent with CCCs 0.94 for the total NFBSI-16 score. Highly significant correlations were documented for all 4 subscales, 16 individual items, and total NFBSI-16 score. Mean differences of the test and re-test were all close to zero (≤0.06). A majority of the participants in this study preferred the web-based (72%, n=255) over the paper-based version. CONCLUSIONS The web-based version of the NFBSI-16 questionnaire is reliable for patients with breast cancer and demonstrated highly significant correlations with the paper-based version in all items, subscales and the total score. The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, also as a majority of participants preferred it over paper-based version.