Validation and responsiveness of the English version of the Chemotherapy-Induced Alopecia Distress Scale (CADS) in breast cancer patients Journal Article


Authors: Kraehenbuehl, L.; Kang, D.; Bang, A. S.; Ketosugbo, K. F.; Hay, J.; Patil, S.; Goldfarb, S.; Cho, J.; Lacouture, M. E.
Article Title: Validation and responsiveness of the English version of the Chemotherapy-Induced Alopecia Distress Scale (CADS) in breast cancer patients
Abstract: Purpose: This study aimed to validate the Chemotherapy-Induced Alopecia Distress Scale (CADS) in a diverse English-speaking population and patients with endocrine treatment-induced alopecia (EIA). Objective: Chemotherapy and endocrine therapy commonly cause alopecia in breast cancer patients, leading to significant psychological and social challenges. The CADS was developed to assess the psychosocial impact of alopecia, but its generalizability beyond Korean patients requires further investigation. Methods: Data from the CHANCE study (NCT02530177), which focused on non-metastatic breast cancer, was used. The cohort included 256 patients, and CADS data were collected at baseline, 6 months after chemotherapy completion, or 12 months after initiating endocrine therapy. The CADS questionnaire comprised 17 items covering physical and emotional health, daily activities, and relationships. Reliability was assessed using Cronbach’s alpha, and responsiveness was measured by effect size. Results: The CADS exhibited good reliability, with Cronbach’s alpha of 0.91 for the overall score, indicating acceptable internal consistency in both chemotherapy (0.89) and endocrine therapy (0.86) groups. Longitudinal responsiveness was supported by an effect size of 0.49 between decreasing satisfaction with hair growth and increasing emotional distress. Cross-sectional validity was confirmed, with effect sizes of 0.91 and 0.92 for satisfaction with hair growth and emotional and activity domains, respectively. Conclusion: The CADS is a valid and responsive tool for assessing the psychosocial impact of chemotherapy-induced alopecia and endocrine treatment-induced alopecia in a diverse Western patient population. © The Author(s) 2024.
Keywords: chemotherapy; oncology; survivorship; alopecia; endocrine therapy; hair loss; supportive care; patient-reported outcome; cancer; oncodermatology
Journal Title: Supportive Care in Cancer
Volume: 32
Issue: 6
ISSN: 0941-4355
Publisher: Springer Verlag  
Date Published: 2024-06-01
Start Page: 369
Language: English
DOI: 10.1007/s00520-024-08564-6
PROVIDER: scopus
PMCID: PMC11108899
PUBMED: 38773008
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is L. Kraehenbuehl -- Source: Scopus
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MSK Authors
  1. Mario E Lacouture
    457 Lacouture
  2. Shari Goldfarb
    149 Goldfarb
  3. Jennifer L Hay
    264 Hay
  4. Alexander Bang
    17 Bang