Patient-Reported Outcome Measures (PROMs) are standardized tools that capture patients’ perspectives on their symptoms, functional status, mental health, and quality of life. Unlike clinical endpoints (like tumor size or survival rates), PROMs provide direct insight into how a patient feels and functions during and after treatment.
In breast cancer research, PROMs are essential for understanding the full impact of diagnosis, treatment, and survivorship—not just in terms of survival, but in the context of a patient’s lived experience.
Common PROMs in Breast Cancer Research
Selecting the right Patient-Reported Outcome Measures (PROMs) is essential for capturing meaningful, high-quality data in breast cancer research. Each PROM instrument has specific domains, strengths, and ideal applications depending on the study goals, treatment phase, and patient population.
Here’s a detailed overview of the most commonly used PROMs in breast cancer research:
1. EORTC QLQ-C30 + QLQ-BR23
The EORTC QLQ-C30 is a core quality of life data collection instrument. It can be expanded by adding the QLQ-BR23, a PROM containing 23 breast-specific items (BR23).
Domains: Together, the EORTC QLQ-C30 and QLQ-BR23 cover the following domains:
- Physical, emotional, cognitive, and social functioning
- Fatigue, pain, nausea/vomiting
- Breast and arm symptoms
- Body image, future perspective, sexual functioning
Strengths: The two PROMs are internationally validated and have a strong history of use in clinical trials. Their modular structure allows flexibility to measure different domains in breast cancer care with a single instrument. Furthermore, they have demonstrated strong psychometric properties across languages and cultures.
Use Case: Ideal for multinational trails assessing health-related quality of life (HRQoL) and treatment side effects in early-stage and metastatic breast cancer.
2. FACT-B (Functional Assessment of Cancer Therapy – Breast)
The FACT-B is a reliable and validated patient-reported outcome measure to measure quality of life in breast care patients. It contains 37 items, consisting of a FACT-G score and a breast cancer subscale.
The FACT-B covers the following domains, making it a robust instrument for both trials involving systemic therapies and longitudinal survivorship studies:
- Physical, emotional, social/family, and functional well-being.
- Breast-specific concerns (e.g., arm mobidity, self-consciousness, lymphedema).
3. Breast-Q
The Breast-Q is a data collection instrument tailored for capturing patient-outcomes following breast surgery or reconstruction. As a modular questionnaire, it can be easily adapted to different surgical pathways and is highly specific to specific surgical interventions (mastetectomy, lumpectomy, reconstruction, augmentation).
Domains: The Breast-Q was developed by Memorial Sloan Kettering Cancer Center in cooperation with the University of British Columbia with patient input, giving it strong face validity across the following domains:
- Satisfaction with breasts and surgical outcomes
- Psychosocial, sexual, and physical well-being
- Satisfaction with care and surgeon communication
4. PROMIS (Patient-Reported Outcomes Measurement Information System)
PROMIS (Patient-Reported Outcomes Measurement Information System) was developed by the NIH as a flexible, domain-based assessment system designed to measure physical, mental, and social health across various populations and diseases. It is available in both fixed-form questionnaires and as Computer Adaptive Testing (CAT), which adjusts in real-time to each patient’s responses to maximize precision while minimizing burden.
Domains: PROMIS covers a wide range of domains relevant to breast cancer research and care, including:
- Pain
- Fatigue
- Depression
- Anxiety
- Physical Function
- Sleep
- Social Roles
Strengths: One of its key strengths is the efficiency and precision of the CAT format, which can significantly reduce the number of questions required without compromising accuracy. PROMIS instruments are also fully digital (ePROM ready), and can be integrated into electronic health records (EHRs) for seamless clinical use.
Because of its flexibility, minimal burden, and broad applicability, PROMIS is especially well-suited for symptom monitoring during and after breast cancer treatment, and is a powerful tool in digitally enabled care environments.
5. MDASI-Breast (M.D. Anderson Symptom Inventory – Breast Module)
MDASI-Breast (M.D. Anderson Symptom Inventory – Breast Module) was developed by MD Anderson Cancer Center to assess symptom burden in breast cancer patients undergoing active treatment. The instrument includes 13 core symptoms common across cancer types, along with 6 additional items specific to breast cancer, such as swelling, breast sensitivity, and arm discomfort.
Domains: This PROM is designed to capture a range of physical and psychological symptoms, including fatigue, nausea, pain, sleep disturbance, and emotional distress. Its concise format makes it highly practical in both clinical and research settings, offering a balance between depth and ease of use. The tool focuses on both symptom severity and the degree to which symptoms interfere with daily functioning.
With validation in multiple languages and a user-friendly design, MDASI-Breast is especially useful for real-time symptom tracking during chemotherapy, radiation therapy, or targeted treatments. Its brevity and clinical relevance make it ideal for routine use in busy oncology settings or in digital platforms supporting remote monitoring.
6. Breast Cancer Treatment Outcome Scale
One important patient-reported outcome measure (PROM) in breast cancer research is the Breast Cancer Treatment Outcome Scale (BCTOS), developed by Harvard-based researchers. This scale is specifically designed to evaluate patient-perceived cosmetic and functional outcomes following breast-conserving therapy. The BCTOS consists of 22 items and covers key domains such as:
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Breast symmetry, shape, scarring, and firmness
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Pain, swelling, and upper-limb function
Its strengths lie in its focused assessment of visual aesthetic outcomes and its ability to capture subtle post-surgical differences from the patient’s perspective. The BCTOS is especially useful in studies comparing breast-conserving surgery with mastectomy or in assessing the impact of radiation therapy on breast appearance.
How PROMs are Used in Breast Cancer Research
Patient-Reported Outcome Measures (PROMs) are central to capturing the patient’s lived experience throughout the breast cancer care continuum—from diagnosis to treatment, recovery, and long-term survivorship. These measures help clinicians and researchers understand symptoms, psychosocial well-being, daily functioning, and overall quality of life from the patient’s point of view.
Here’s how PROMs are used in various aspects of breast cancer research and care:
1. Evaluating Treatment Outcomes Beyond Clinical Metrics
Traditional endpoints in breast cancer research (e.g., tumor response, progression-free survival) often overlook the human cost of treatment. PROMs fill this gap by measuring:
Pain intensity and management efficacy
Fatigue and energy levels, which are commonly impacted by chemotherapy and radiation
Body image and self-esteem, especially after surgery or mastectomy
Cognitive function, such as memory or “chemo brain” symptoms
Sexual functioning and intimacy, which may be affected by hormonal therapy or surgery
Emotional distress, including anxiety, depression, and fear of recurrence
By integrating these data points, researchers can assess treatment tolerability, guide supportive care interventions, and refine clinical decision-making based on what matters most to patients.
2. Enriching Clinical Trials with Patient-Centered Endpoints
Modern clinical trials for breast cancer treatments are increasingly incorporating PROMs to evaluate:
Quality of life differences between treatment arms
Time to symptom worsening (TSW) as a novel endpoint
Functional recovery post-intervention, such as after breast reconstruction or axillary surgery
Including PROMs in trials can enhance regulatory submissions, support FDA labeling claims, and help developers differentiate therapies based on patient-centric value. For example:
Trials comparing neoadjuvant vs. adjuvant chemotherapy may use PROMs to assess which approach better preserves quality of life.
Studies on new endocrine therapies can measure long-term side effects like joint pain or fatigue via PROMIS or EORTC instruments.
These insights empower both clinicians and patients to evaluate the trade-offs between clinical benefit and quality of life.
3. Informing Shared Decision-Making in the Clinic
PROM data can support real-time conversations between breast cancer patients and their care teams. Tools like BREAST-Q and decision aids use PROMs data to visualize:
Expected quality-of-life outcomes by treatment type
Patient priorities such as preserving function or appearance
Emotional recovery timelines and risks of regret
For example, a patient considering breast-conserving surgery versus mastectomy with reconstruction can explore projected satisfaction scores from thousands of women with similar profiles. This fosters individualized, preference-sensitive decisions.
4. Tracking Patient Well-being in Survivorship Care
Long after active treatment ends, breast cancer survivors face persistent challenges. PROMs play a key role in monitoring and managing:
Late effects of radiation or chemotherapy (e.g., neuropathy, fatigue)
Endocrine-related symptoms (e.g., hot flashes, vaginal dryness)
Psychosocial health, including fear of recurrence, body image concerns, and workplace reintegration
Health-related quality of life (HRQoL) across domains like sleep, mobility, and social roles
Survivorship PROMs are often collected at 6-month, 12-month, and annual intervals to track recovery and support tailored survivorship care plans.
5. Identifying Disparities and Driving Health Equity
PROMs can uncover disparities in breast cancer care experiences across race, ethnicity, socioeconomic status, language, geography, and more. For instance:
Non-English-speaking patients may report lower satisfaction with communication
Younger survivors may experience higher distress or unmet fertility needs
Rural patients may face access-related quality-of-life limitations
These insights can inform targeted interventions, inclusive clinical trial design, and resource allocation to improve equity and access in breast cancer care.
6. Contributing to Health System Performance & Value-Based Care
Health systems are beginning to use PROMs data at the population level to:
Benchmark quality across institutions
Justify funding for supportive services (e.g., psycho-oncology, lymphedema therapy)
Power value-based reimbursement models that reward improvements in patient-reported outcomes, not just clinical endpoints
PROMs like those in the ICHOM Standard Set for Breast Cancer allow health systems to globally compare and improve care based on outcomes that matter most to patients.
Designing PROMs Studies in Breast Cancer Research
To ensure PROMs data are meaningful and actionable, breast cancer researchers must design studies with rigor and patient-centeredness in mind. Here’s how:
1. Define Clear Research Objectives
Clarify what you aim to measure: treatment comparison, survivorship trends, symptom burden, or disparities in outcomes. This shapes the choice of tools and timing.
2. Choose Appropriate PROM Instruments
Select validated instruments that align with your objectives:
Use EORTC QLQ-BR23 or FACT-B for overall QoL
Use BREAST-Q for surgical outcomes
Use PROMIS or MDASI-BC for symptom tracking
Ensure tools are culturally and linguistically validated.
3. Plan Assessment Timing Thoughtfully
Collect data at key time points:
Baseline (pre-treatment)
During treatment
End of treatment
Follow-up (e.g., 6–12 months later)
Avoid overburdening patients—consider short forms or adaptive testing.
4. Implement ePROMs Where Possible
Digital tools improve accessibility and compliance. ePROM platforms support:
Mobile and web-based surveys
Real-time symptom alerts
EHR integration
Ensure digital equity for patients with limited tech access.
5. Engage Patients and Stakeholders
Co-design PROM strategies with patients, clinicians, and researchers. This improves relevance, language clarity, and patient engagement—boosting response rates and data quality.
6. Plan for Robust Data Management
Use platforms like REDCap or PROcore for secure, structured data collection. Pre-define approaches for handling:
Missing data
Longitudinal modeling
Clinically meaningful change (e.g., MID thresholds)
7. Ensure Regulatory and Ethical Compliance
Follow FDA/EMA guidance for PROMs in oncology trials. Secure ethical approvals that minimize burden and prioritize consent. Comply with data protection regulations (HIPAA, GDPR).
8. Design for Translation and Impact
Build in pathways for PROMs findings to inform clinical practice:
Use PROM data in shared decision-making tools
Report findings in accessible formats
Engage healthcare organizations to act on results