A systematic review of the measurement properties of the Body Image Scale (BIS) in cancer patients

Heleen C. Melissant, Koen I. Neijenhuijs, Femke Jansen, Neil K. Aaronson, Mogens Groenvold, Bernhard Holzner, Caroline B. Terwee, Cornelia F. van Uden-Kraan, Pim Cuijpers, Irma M. Verdonck-de Leeuw

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38 Citations (Scopus)


INTRODUCTION: Body image is acknowledged as an important aspect of health-related quality of life in cancer patients. The Body Image Scale (BIS) is a patient-reported outcome measure (PROM) to evaluate body image in cancer patients. The aim of this study was to systematically review measurement properties of the BIS among cancer patients.

METHODS: A search in Embase, MEDLINE, PsycINFO, and Web of Science was performed to identify studies that investigated measurement properties of the BIS (Prospero ID 42017057237). Study quality was assessed (excellent, good, fair, poor), and data were extracted and analyzed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology on structural validity, internal consistency, reliability, measurement error, hypothesis testing for construct validity, and responsiveness. Evidence was categorized into sufficient, insufficient, inconsistent, or indeterminate.

RESULTS: Nine studies were included. Evidence was sufficient for structural validity (one factor solution), internal consistency (α = 0.86-0.96), and reliability (r > 0.70); indeterminate for measurement error (information on minimal important change lacked) and responsiveness (increasing body image disturbance in only one study); and inconsistent for hypothesis testing (conflicting results). Quality of the evidence was moderate to low. No studies reported on cross-cultural validity.

CONCLUSION: The BIS is a PROM with good structural validity, internal consistency, and test-retest reliability, but good quality studies on the other measurement properties are needed to optimize evidence. It is recommended to include a wider variety of cancer diagnoses and treatment modalities in these future studies.

Original languageEnglish
Pages (from-to)1715-1726
Number of pages12
JournalSupportive Care in Cancer
Issue number6
Early online date12 Mar 2018
Publication statusPublished - 1 Jun 2018


  • Body Image Scale
  • Body image
  • Cancer
  • Measurement properties
  • PROM
  • Systematic review

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