Validation of a Novel, Multidomain Head and Neck Cancer Appearance- and Function-Distress Patient-Reported Outcome Measure

Otolaryngol Head Neck Surg. 2020 Nov;163(5):979-985. doi: 10.1177/0194599820927364. Epub 2020 Jun 2.


Objectives: Distress with self-perceived changes in appearance and function can result in body image disturbance (BID), which is common in head and neck cancer (HNC) survivors and a major source of psychosocial morbidity. To address the lack of psychometrically sound patient-reported outcome measures (PROMs) of HNC-related BID, we aim to create and validate the Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN).

Study design: Survey study.

Setting: Multiple academic centers.

Subjects and methods: Following item development, HNC survivors from 4 academic centers completed the IMAGE-HN. Item responses were psychometrically analyzed using confirmatory factor analysis (CFA) and Rasch analysis.

Results: Item development resulted in a 31-item PROM consisting of 5 individual domains and a global domain. In total, 305 HNC survivors of diverse ages, HNC subsites, and reconstructive paradigms completed the initial items. After removal of 3 items for local dependence, CFA confirmed the unidimensionality and local independence (item residual correlations <|0.20|) for each domain. Rasch analysis indicated acceptable fit (infit and outfit mean squares <2.0), monotonicity of all rating scale categories, and low person misfit (<4%). Person separation indices and person reliability were adequate for each domain except appearance concealment, which was removed (4 items). This resulted in the IMAGE-HN, a psychometrically acceptable 24-item PROM of HNC-related BID consisting of a global scale and 4 subscales measuring unique constructs and comprised independent items.

Conclusions: IMAGE-HN is a novel, psychometrically sound, multidomain PROM of HNC-related BID for use in clinical and research settings.

Keywords: PROMIS; appearance; body image; disfigurement; head and neck cancer; patient reported outcome measure; pyscho-oncology; survivorship.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Body Image* / psychology
  • Cancer Survivors / psychology*
  • Factor Analysis, Statistical
  • Female
  • Head and Neck Neoplasms / psychology
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures*
  • Plastic Surgery Procedures*
  • Psychometrics
  • Self Report
  • Socioeconomic Factors
  • Young Adult