@Article{info:doi/10.2196/18269,
author="Ma, Jinfei
and Zou, Zihao
and Pazo, Emmanuel Eric
and Moutari, Salissou
and Liu, Ye
and Jin, Feng",
title="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",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="2",
volume="9",
number="3",
pages="e18269",
keywords="breast cancer; NFBSI-16; patient-reported outcome; reproducibility; test-retest reliability; web-based questionnaire",
abstract="Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network--Functional Assessment of Cancer Therapy--Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. 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 were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall $\tau$ rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman $\rho$) were documented for all 4 subscales---Disease-Related Symptoms Subscale--Physical ($\rho$=0.93), Disease-Related Symptoms Subscale--Emotional ($\rho$=0.85), Treatment Side Effects Subscale ($\rho$=0.95), and Function and Well-Being Subscale ($\rho$=0.91)---and total NFBSI-16 score ($\rho$=0.94). Mean differences of the test and retest were all close to zero (≤0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0{\%}) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. ",
issn="2291-9694",
doi="10.2196/18269",
url="https://medinform.jmir.org/2021/3/e18269",
url="https://doi.org/10.2196/18269",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650978"
}