Development and validation of chemotherapy-induced alopecia distress scale (CADS) for breast cancer patients

Background: A psychometric scale for assessing the distress that breast cancer patients experience due to the chemotherapy-induced alopecia was developed and validated. Patients and methods: Twenty-five items for chemotherapy-induced alopecia distress were developed based on a qualitative study, and a cross-sectional survey was conducted with 305 Korean women with breast cancer. To extract factor structure and evaluate construct validity, exploratory and confirmatory factor analysis (CFA) was carried out. Concurrent and discriminant validity were tested by correlations with the psychosocial factors. In addition, external validity analysis was conducted using data from another prospective study of 428 breast cancer patients. Results: Exploratory factor analysis and CFA yielded 17 items in four domains and the model fit was good (CFI = 0.925). Coefficient alphas ranged from 0.77 to 0.95 for subdomains and 0.95 for total, and it was similar with the validation dataset confirming its external validity. The total Chemotherapy-Induced Alopecia Distress Scale (CADS) was moderately correlated with the body image (r = -0.47, P < 0.001), more weakly correlated with the patients' overall quality of life (QOL, r = -0.28, P < 0.001), but did not correlate with self-esteem (r = -0.07, P = 0.23). Conclusions: Our study confirmed that the CADS is a reliable and valid tool for measuring distress of chemotherapyinduced alopecia.