No a priori hypotheses were formulated in four studies [15, 17, 18, 33], and in those cases, we assumed the hypothesis would be that BIS scores are higher (worse) (1) in patients who were treated with a mastectomy compared to patients treated with BCS [34] or breast reconstruction [35], (2) in younger patients compared to older patients [36], (3) in patients with a longer time since treatment [37], and (4) in patients with a stoma vs. without a stoma [38]. Therefore, further research is needed to establish these anchor points on changes that are important. However, not all measurement properties were taken into account (i.e., measurement error and responsiveness). Although measurement error was not reported in the included studies, we were able to calculate the standard error of measurement (SEM) and the smallest detectable change (SDC) in three studies reporting reliability data and standard deviations. https://doi.org/10.1007/s00520-014-2383-0. Patients with cancer are often faced with invasive treatments, with a temporal or permanent impact on appearance. Qual Life Res 19:539–549. Two independent extractors (KN and FJ) who identified eligible studies extracted information on each of the measurement properties defined in the COSMIN taxonomy [21]. https://doi.org/10.1007/s11136-018-1798-3, CAS  Eur J Cancer 37(2):189–197, 2001) and to analyze its psychometric properties in a sample of women with breast or gynaecological cancer. The databases Embase, MEDLINE, PsycINFO, and Web of Science were systematically searched for publications directly investigating aspects of measurement properties of the BIS. 5. PubMed  A total sample of 100 women who had undergone radical surgery for breast (n = 50) or gynaecological cancer (n = 50) completed the scale. Various generic scales have been used for measuring body image in women with breast cancer, while specific ... BIS by Hopwood, Fletcher, Lee and Al Ghazal (2001), and among the non-specific scales, the MBA by Carver et al., (1998). The study used the Body Image Scale by Hopwood, Fletcher, Lee and Al Ghazal (2001; Polish adaptation by Brandt-Salmeri and Przybyła-Basista), Rosenberg Self-Esteem Scale – SES (Polish adaptation by Łaguna, Lachowicz-Tabaczek and Dzwonkowka, 2007) and an original survey. https://doi.org/10.1188/07.ONF.E36-E41, Taylor-Ford M, Meyerowitz BE, D’Orazio LM, Christie KM, Gross ME, Agus DB (2013) Body image predicts quality of life in men with prostate cancer. 7. Qual Life Res 24:1629–1633. Table 1 summarizes the characteristics of the included studies. The authors thank Maria Die-Trill (University General Hospital ‘Gregorio Marañón’, Madrid, Spain) for her assistance during the data collection process. https://doi.org/10.1016/J.JCLINEPI.2006.03.012, Gómez-Campelo P, Bragado-Álvarez C, Hernández-Lloreda MJ, Sánchez-Bernardos ML (2015) The Spanish version of the Body Image Scale (S-BIS): psychometric properties in a sample of breast and gynaecological cancer patients. In one study, screening of body image in patients with advanced cancer (locally advanced, recurrent, or metastatic) was specifically the focus [18]. ¿Le resulta difícil mirarse cuando está desnuda(o)? ¿Se ha sentido menos femenina/masculino como consecuencia de su enfermedad o tratamiento? All nine included studies reported on internal consistency using Cronbach’s alpha (α) (Table 3). The authors declare no conflict of interest. (2017) presented a review of PROMs measuring body image in cancer patients, including the BIS, and concluded that the measurement properties of these PROMs require more thorough investigation [20]. J Clin Oncol 26(8):1269–1274, Dalton EJ, Rasmussen VN, Classen CC, Grumann M, Palesh OG, Zarcone J et al (2009) Sexual adjustment and body image scale (SABIS): a new measure for breast cancer patients. YOU MUST BE AT LEAST 18 YEARS OLD to participate in this research survey. Six studies reported on convergent validity with other body image-related instruments, psychological function, or HRQOL scales (Table 4). Each study was rated by a single rater (HM), whose ratings were checked by a second independent rater (KN). in 2001 to measure affective, behavioral, and cognitive body image symptoms. https://doi.org/10.1002/cncr.26632, Fingeret MC, Nipomnick S, Guindani M, Baumann D, Hanasono M, Crosby M (2014) Body image screening for cancer patients undergoing reconstructive surgery. - 5.189.150.71. PubMed Central  Body image is the subjective representation of perception, evaluation, assessment and experience of the body that provides the sense of self as a ... and reliability were found.The Body Image Scale of Hopwood and module QLQ BR 23 of the European Organization for Research and Treatment of Cancer were reported in studies in Latin American population. Qual Life Res 18:1115–1123. J Psychosoc Oncol 1:17–33. Relevant data included the study population, sample size, the method, information on missing values, type of measurement property, and its outcome. Breast J 15(3):287–290, Lasry JM, Margolese RG, Poisson R, Shibata H, Fleischer D, Lafleur D et al (1987) Depression and body image following mastectomy and lumpectomy. BIS (Body Image Scale) de Hopwood, según la cual, se clasificó a las pacientes en imagen corporal completa o incompleta. Article  Cancer 118:3095–3104. PubMed  Google Scholar, Hopwood P, Haviland J, Mills J, Sumo G, Bliss JM, START Trial Management Group (2007) The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Patients can indicate body image symptoms on a 4-point scale (0 “not at all” to 3 “very much”). presenting adequate convergent validity [20]. This grade was based on (i) risk of bias, (ii) indirectness, (iii) inconsistency of results, and (iv) imprecision of studies. The BIS is a 10-item self-report measure that assesses affective (e.g., feeling self-conscious of the body), behavioural (e.g., difficulty at looking at the naked A higher score means a higher level of body image disturbance [14]. Out of five studies with fair quality [15,16,17, 31, 33], two studies confirmed the hypotheses [15, 16]. Body image The body image scale [BIS] (Hopwood et al., 2001) is a 10 item measure developed to briefly and comprehensively assess affective (e.g. The search was performed in July 2016 and updated in July 2017 to verify new publications. The Spanish version of the Body Image Scale was developed using a forward and backward translation technique . Background: In Manchester, approximately 120 women at ≥1: 4 lifetime risk of breast cancer have considered preventative surgery since 1992. The low value of 0.67 may be an underestimation of the true reliability because of the long time interval. It is clini- One study of good quality [14] found a significant increase in body image disturbance for the overall sample (n = 55) and for the BCS and mastectomy subgroups 2 weeks to 4 months postoperatively, indicating sufficient responsiveness. Regarding validity, existing evidence on content validity should be summarized and new evidence is needed for cross-cultural validity. Psychol Health Med 13(3):313–325, Hopwood P (1993) The assessment of body image in cancer patients. Clín Salud 8(3):403–422, Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring anxiety: psychometric properties. If there were inconsistencies between studies, explanations were explored. Two studies reported on responsiveness. Furthermore, it would be valuable to examine structural validity on a possible two-factor structure among cancer subgroups (patients who had reconstructive surgery or amputation of a body part) more thoroughly. https://doi.org/10.1016/j.ejca.2008.09.003, Terwee CB, Prinsen CA, Chiarotto A, Westerman MJ, de Vet HC, Patrick D, Alonso J, Bouter LM, Mokkink LB (2016) Consensus-based standards and criteria for evaluating the content validity of patient-reported outcome measures: a COSMIN Delphi study. Before the actual search, a search for reviews and meta-analyses of the measurement properties of each of the 39 PROMs was performed. (STAI), The Rosenberg Self-Esteem Scale (RSES), 10-item Body Image Scale (BIS). https://doi.org/10.1007/s10549-011-1798-2, Dua P, Heiland MF, Kracen AC, Deshields TL (2017) Cancer-related hair loss: a selective review of the alopecia research literature. After discussion with a multidisciplinary panel, this Hopwood BIS was selected for use in our study. Irma M. Verdonck-de Leeuw. None of the studies presented results on cross-cultural validity or criterion validity. EORTC Quality of Life Study Group. The poor quality study did not formulate a hypothesis a priori [18]. Recently, this protocol has become available [42]. The good and fair quality studies reported values of r = 0.92 [15] and r = 0.85 [32], indicating sufficient results. https://doi.org/10.1007/s11136-011-9960-1, Terwee CB, Bot SD, De Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. It is recommended to include a wider variety of cancer diagnoses and treatment modalities in these future studies. The Spanish version of the Body Image Scale was developed using a forward and backward translation technique . The study populations were breast cancer patients [14, 17, 33], colorectal cancer patients [19], patients with an ostomy (included because 82% of the population were cancer patients) [32], or a mixed cancer population (including breast, gynecological, gastro-intestinal, genitourinary, head and neck, hematologic, and respiratory cancer) [18, 31]. 2), 47±50. Negative correlation was found between uncertainty and quality of life in the group of women rebuilt, in turn is a direct correlation between body image and low For example, hypothesis testing for construct validity is rated as “sufficient” if at least 75% of the results are in accordance with the hypotheses. For this reason, and due to the lack of clearly stated a priori hypotheses, quality of evidence of construct validity was graded as low. Supportive Care in Cancer Methodological aspects regarding design requirements and preferred statistical methods, specific to the measurement properties under consideration were rated on a 4-point scale: “excellent,” “good,” “fair,” or “poor.” In accordance with COSMIN recommendations, overall methodological quality per measurement property of the BIS was obtained by taking the lowest rating of any of the methodological aspects assessed [29]. https://doi.org/10.1111/jocn.12753, Duman-Lubberding S, van Uden-Kraan CF, Jansen F, Witte BI, van der Velden LA, Lacko M, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM (2016) Feasibility of an eHealth application “OncoKompas” to improve personalized survivorship cancer care. With respect to convergent validity, correlations with other body image scales were inconsistent. https://doi.org/10.1007/s00520-018-4145-x, DOI: https://doi.org/10.1007/s00520-018-4145-x, Over 10 million scientific documents at your fingertips, Not logged in Discrepancies in ratings were discussed until consensus was reached. Responses to these items will be collected via Survey Monkey and will be completely confidential and anonymous. https://doi.org/10.1007/s00520-015-3004-2, Terwee CB, Jansma EP, Riphagen II, De Vet HC (2009) Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. The Spanish version of the Body Image Scale (S-BIS): psychometric properties in a sample of breast and gynaecological cancer patients. An overall summary of the results for every measurement property of the BIS is shown in Table 5. Psychooncology 23:898–905. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017057237. Second, criteria for good measurement properties were applied to the results of the included studies, following the COSMIN guidelines for systematic reviews of PROMs [27, 30]. PubMed  Eur J Cancer. Since then, the BIS was validated in several other languages such as Dutch, Greek, and Portuguese [15,16,17] and across diverse cancer populations, e.g., in advanced cancer patients and colorectal cancer patients [18, 19]. Disagreements regarding inclusion and exclusion were discussed until consensus was reached. J Clin Psychol Med Settings 16:311–321. structured interview, one Socioeconomic Tab, Body Image Scale Hopwood and Rosenberg Self-Esteem Scale was applied. The 10-item Body Image Scale was developed by Hopwood et al. The one study that found a correlation < 0.70 had a large time interval (6 months) between the two measurements and was therefore judged as having a poor methodological quality. Further research including a wider variety of cancer patients and treatment modalities is recommended. The Body Image Scale (BIS) is a patient-reported outcome measure (PROM) to evaluate body image in cancer patients. https://doi.org/10.1016/S0959-8049(00)00353-1, CAS  2001 Jan;37(2):189-97 (PubMed Abstract) Br J Community Nurs 7(11):563–566, Miller SJ, Schnur JB, Weinberger-Litman SL, Montgomery GH (2013) The relationship between body image, age, and distress in women facing breast cancer surgery. These two factors were labeled as “attractiveness” and “satisfaction with body” [14, 16]. Therefore, the aim of this current study was to conduct a systematic review specifically focusing on the measurement properties of the BIS in cancer patients, following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Internal consistency (Cronbach’s alpha) was 0.960. Breast Cancer Res Treat 131:957–967. Body Image 1(1):83–97, PubMed  Given these contradictory findings and the fair quality of these studies, no firm conclusions can be drawn about convergent validity of the BIS. Evidence on hypothesis testing for construct validity was inconsistent since findings for known-group comparisons and convergent validity were inconsistent. Psychooncology 26:438–443. Ann Behav Med 32:77–81. This is in contrast to other PROMs that aim to measure body image in non-cancer populations (e.g., Appearance Schemas Inventory-Revised (ASI-R)) [10] or in cancer patients with specific types of cancer or treatment (e.g., Breast Impact of Treatment Scale (BITS) in breast cancer patients, Sexual Adjustment and Body Image Scale (SABIS-g) in gynecologic cancer patients, and Body Image Screener for Cancer Reconstruction (BICR) for patients after breast reconstruction) [11,12,13]. Efforts are therefore needed to reach consensus on a measure that could serve as second best. Psychooncology 22:756–761. High-quality studies exploring convergent validity with investment in appearance (ASI-R) and self-esteem (RSES) are recommended. With respect to reliability, this includes examining measurement error and research on minimal important change. To our knowledge, this is the first study that provides a Spanish version of the Body Image Scale. 1985 40 Prospective pre-op, 3 Semi-structured i/v Unstandardised and 12 months plus in-house scale of postoperatively body satisfaction Bartelink et al. Having applied inclusion and exclusion criteria, 177 studies were excluded after title/abstract screening. Inflamm Bowel Dis 20(2):286–290, Moreira H, Silva S, Marques A, Canavarro C (2010) The Portuguese version of the Body Image Scale (BIS)—psychometric properties in a sample of breast cancer patients. https://doi.org/10.1007/s10549-012-2349-1, Metzger LF, Rogers TF, Bauman LJ (1983) Effects of age and marital status on emotional distress after a mastectomy. Google Scholar, Muzzatti B, Annunziata MA (2017) Body image assessment in oncology: an update review. PROSPERO:CRD42017057237. Search results were checked for duplications. PubMed  Princeton University, Princeton, Echeburúa E (1995) Evaluación y tratamiento de la fobia social. The Psychological Corporation, San Antonio, Vázquez C, Sanz J (1997) Fiabilidad y valores normativos de la versión española del inventario para la depresión de Beck de 1978. These results were qualitatively summarized to obtain an overall rating of the measurement property across all included studies: sufficient (+), insufficient (−), “inconsistent” (±) or indeterminate (?). This is a brief and psychometric robust measure of body image for use with cancer patients, independently of age, cancer type, treatment or stage of the disease and it was developed in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Study Group. © 2021 Springer Nature Switzerland AG. European Organisation for Research and Treatment of Cancer, Brussels, MacCallum RC, Widman KF, Zhang S, Hong S (1999) Sample size in factor analysis. Eur J Cancer 45:119–126. Ansiedad Estrés 9(1):59–84, Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. The total score ranges from 0 to 30 and can be calculated by summing up the 10 items. Based on these findings, structural validity of the BIS overall was rated sufficient (+) because two studies of at least good quality and three studies of fair quality support unidimensionality of the scale. https://doi.org/10.1007/s11136-009-9528-5, Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, Terwee CB (2018) COSMIN guideline for systematic reviews of patient-reported outcome measures. Its brevity and comprehensibility allow a quick assessment both in clinical and research settings. https://doi.org/10.1007/s00520-014-2383-0, DOI: https://doi.org/10.1007/s00520-014-2383-0, Over 10 million scientific documents at your fingertips, Not logged in Of the remaining 47 studies, 37 were excluded after full-text screening and one was excluded during data extraction. Body Image Scale: Hopwood: 10: Self‐consciousness, feeling less physically attractive, dissatisfied with appearance, less feminine, difficulty seeing self naked, feeling less sexually attractive, avoiding people, feeling body is less whole, being dissatisfied with body, dissatisfied with scar: 0 … The group treatment had 9 an-hour-and-a-half- sessions, once a week. Google Scholar, van Verschuer VM, Vrijland WW, Mares-Engelberts I, Klem TM (2015) Reliability and validity of the Dutch-translated Body Image Scale. [33] after surgery with immediate breast reconstruction. However, correlation with investment in appearance (ASI-R) was low [17, 18]. Eur J Cancer 13(2):276–281, Sebastián J, Manos D, Bueno MJ, Mateos N (2007) Imagen corporal y autoestima en mujeres con cáncer de mama participantes en un programa de intervención psicosocial. The gold standard practice is to have the assessment done by two raters independently because raters initially may have different opinions and consensus is needed. Nutr Hosp 28(5):1453–1457, CAS  Body Image Inventory: Spanish body image Inventory: Autor(es) Gómez-Campelo P : Hopwood P : Referencia: Support Care Cancer (2015) 23:473-481: Hopwood P, Fletcher I, Lee A, Al Ghazal S (2001) A body image scale for use with cancer patients. The precise filter was a pragmatic choice because a sensitive filter would provide too many hits to feasibly screen since the overall search encompassed 39 PROMs (Prospero ID 42017057237) [22]. No conflicts of interest exist for any of the authors of this study. However, three other fair quality studies [16, 17, 33] presented low correlations (r < 0.40) with most of the related constructs, indicating insufficient convergent validity. - BCT and mastectomy with breast reconstruction). Int J Color Dis 25:369–374. Based on these findings, hypothesis testing for construct validity was rated as inconsistent (±) because although three studies showed sufficient evidence (> 75% of the hypotheses on known-groups and/or convergent validity confirmed) [14, 15, 31], this was contradicted by four studies showing insufficient evidence [16, 17, 19, 33]. However, these data are difficult to interpret since no information is available on the anchor points minimal important change (MIC) or minimal important difference (MID). EORTC, Brussels, Rosenberg M (1965) Society and the adolescent self-image. 1). Eur J Cancer 37:189–197. https://doi.org/10.1002/pon.3063, Howell D, Molloy S, Wilkinson K, Green E, Orchard K, Wang K, Liberty J (2015) Patient-reported outcomes in routine cancer clinical practice: a scoping review of use, impact on health outcomes, and implementation factors. When only taking into account good and fair quality studies, the smallest change in score that can be detected, that is not due to measurement error, ranges between 4.7–9.1 [15, 32], on a total range of 0–30 of the BIS. Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. feeling self-conscious), behavioural (e.g. volume 23, pages473–481(2015)Cite this article. Behav Res Methods 38(1):88–91, Cash T, Melnyk S, Hrabosky J (2004) The assessment of body image investment: an extensive revision of the Appearance Schemas Inventory. Ann Oncol 26:1846–1858. Search terms were the measurement instrument’s name and its acronym, combined with search terms (text words and key words) for cancer, and a precise filter for measurement properties (Appendix A) [26]. This contradicts the conclusion of Muzzatti et al. The Spanish version of the Body Image Scale correlated negatively with self-esteem (r = −0.733), quality of life (r = −0.632) and age (r = −0.643) and positively with depression (r = 0.832) and anxiety (r = 0.564); all p values <0.01. A need was identified to develop a short body image scale (BIS) ... Hopwood P, Maguire P. Body image problems in cancer patients. J Psychosom Res 70:395–402. The field of body image was … Eur J Oncol Nurs 14(2):111–118, Khang D, Rim HD, Woo J (2013) The Korean version of the body image scale-reliability and validity in a sample of breast cancer patients. Quality of the evidence was moderate to low. https://doi.org/10.1016/j.ejon.2009.09.007, Rhondali W, Chisholm GB, Filbet M, Kang DH, Hui D, Cororve Fingeret M, Bruera E (2015) Screening for body image dissatisfaction in patients with advanced cancer: a pilot study. Article  Body image is a multi-dimensional construct and comprises cognitive, behavioral, and affective aspects of appearance [1]. No relationship was found between BI and CS, and these did not vary according to the surgical procedure ... Hopwood, P., Fletcher, I., Lee, A., & Al Ghazal, S. (2001). https://doi.org/10.1300/J077v01n03_02, Sneeuw KC, Aaronson NK, Yarnold JR, Broderick M, Regan J, Ross G, Goddard A (1992) Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. Learn more about Institutional subscriptions, Rumsey N, Harcourt D (2004) Body image and disfigurement: issues and interventions. J Natl Cancer Inst 85(5):365–376, Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A et al (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. 2001): questionnaire and scoring (Cheli et al.. 2016). 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. Clín Salud 18(2):137–161, Annunziata MA, Giovannini L, Muzzatti B (2012) Assessing the body image: relevance, application and instruments for oncological settings. Oral Oncol 49:753–760. https://doi.org/10.1016/S1740-1445(03)00005-6, Falk Dahl CA, Reinertsen KV, Nesvold IL, Nesvold IL, Fosså SD, Dahl AA (2010) A study of body image in long-term breast cancer survivors. The Body Image Scale (BIS) is a PROM developed to measure body image in all types of cancer patients. https://doi.org/10.1007/s00384-009-0851-7, Article  J Clin Epidemiol 60:34–42. Comparison of patients’ ratings, observers’ ratings and objective assessments. Qual Life Res 25:1–1. Only one study of good methodological quality reported a change in BIS scores postoperatively [14], but no hypotheses were formulated on the expected magnitude of change and no comparison with another instrument was made. We report on the results based on data extracted from nine studies addressing structural validity, internal consistency, reliability, hypothesis testing for construct validity, and responsiveness. The initial development and validation study of the BIS showed good measurement properties concerning internal consistency, known-group comparison and responsiveness among English-speaking breast cancer patients [14]. However, one fair quality study and subgroup analyses in two good quality studies showed a two-factor structure [14, 16, 33]. Psychiatry Investig 10(1):26–33, PubMed Central  Instruments originated in Europe and the United States, with the psychometric properties of validity and reliability were found.The Body Image Scale of Hopwood and module QLQ BR 23 of the European Organization for Research and Treatment of Cancer were reported in … This may comprise body image scores by proxies such as health care providers with vast experience in the targeted study population. Article  It should be noted that in some studies, a two-factor solution was also found. Nine studies were included. In total, we included nine studies that investigated measurement properties of the BIS in cancer patients (see Fig. The other study had poor quality [19] because of a small sample size (n = 17) and found no change in BIS scores from before to after surgical treatment. https://doi.org/10.1002/pon.3491, Hopwood P, Fletcher I, Lee A, Al Ghazal S (2001) A body image scale for use with cancer patients. Br J Psychiatry 1988, 153 (Suppl. The Body Image Scale (BIS), designed for the assessment of body image in cancer patients to be completed after surgery, 9,18 consists of 10 items scored from 0 (not at all) to 3 (very much), concerning impact of surgery on self-consciousness, physical and sexual attractiveness, femininity, satisfaction with body and scars, body integrity, and avoidance behavior. If you wish to order and print the BISS and the Scoring Instructions, and you agree to the above terms, CLICK the following link and provide the necessary information as requested. First, we rated the methodological quality of the included studies, based on the COSMIN checklist for assessing the methodological quality of studies on measurement properties [28]. satisfaction with appearance) dimensions of body image in cancer patients and has been designed https://doi.org/10.1111/2047-3095.12049, Khang D, Rim HD, Woo J (2013) The Korean version of the body image scale-reliability and validity in a sample of breast cancer patients. Supportive Care in Cancer The quality of evidence of structural validity was graded as moderate due to inconsistent findings. This study was part of a larger systematic review (Prospero ID 42017057237) [22], investigating the validity of 39 PROMs measuring quality of life of cancer survivors included in an eHealth application called “Oncokompas” [23,24,25]. The aim of this study is to develop a Spanish version of the Body Image Scale (Hopwood et al. Beyond body image as a trait: The development and validation of the Body Image States Scale. However, there was no agreement on which items belonged to which factors precisely.

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